Comparison of three caval reconstruction techniques in orthotopic liver transplantation: A retrospective review

Chan, Tiffany; DeGirolamo, Kristin; Chartier-Plante, Stephanie; Buczkowski, Andrzej K.

doi:10.1016/j.amjsurg.2017.03.045

Cited by 21 publications

(14 citation statements)

References 21 publications

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“…This modified piggyback technique has been described in the literature and compared with the standard piggyback technique and end-to-side cavocavostomy. 26 Studies have shown lower rates of intraoperative blood products, vascular complications, and reduced warm ischemia time with this technique in adult liver transplantation. [27][28] A more recent study by Lee et al comparing side-to-side cavocavostomy with traditional piggyback has similarly found decreased intraoperative transfusion requirements and rates of temporary abdominal closure.…”

Section: Discussionmentioning

confidence: 99%

“…Proportion of male recipients was significantly lower in the pediatric-donor group when compared with the adult-donor group (4 [33%] versus 20 [83%], respectively; P = 0.007). Recipients in the pediatricdonor group had significantly lower BMI versus recipients in the adult-donor group (24 [22][23][24][25][26][27][28][29][30][31] versus 30 [28][29][30][31][32][33][34][35], respectively, P = 0.013). Etiologies of liver disease were similar between groups, with alcohol-related cirrhosis being the most common on both groups, followed by hepatitis C virus cirrhosis and nonalcoholic steatohepatitis (41.7%, 25% and 8.3% in the pediatric-donor group, respectively; and 50%, 25%, and 8.3% in the adult-donor group, respectively; P = 0.96).…”

Section: Recipient Preoperative Characteristicsmentioning

confidence: 99%

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Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts

Vargas

Wang

Dalzell

et al. 2022

Transplantation Direct

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Background. The use of pediatric grafts for liver transplantation (LT) into adult recipients is rare, and reported outcomes are conflicting. The aim of this study is to evaluate the outcomes in adult recipients following LT with grafts from deceased pediatric donors. Methods. A retrospective study identifying adult LT between 2010 and 2020 using pediatric deceased donor liver grafts was conducted. Adults undergoing LT with deceased donor pediatric grafts (age ≤ 12) were identified and matched 1:2 with adults receiving adult grafts (age ≥ 18) based on recipient age (±10 y), model for end-stage liver disease (MELD) score at transplant (±5 points) and etiology of liver disease. To assess real liver size differences between the pediatric-donor and adult-donor groups, patients receiving a graft from a donor between 13 and 17 y were excluded from the main analysis and studied independently. Outcomes between the groups were compared. Complication rates were identified and graded using Clavien–Dindo classification. Graft and patient survival were assessed by Kaplan–Meier curves. Results. Twelve adult LT recipients with whole liver grafts from deceased pediatric donors were matched with 24 adult recipients of adult donors. Recipient age and MELD score were similar between groups. Recipients of pediatric grafts were more likely to be female (66.7% versus 16.7%, P = 0.007) and leaner (body mass index = 24.4 versus 29.9, P = 0.013). Alcohol-related cirrhosis was the most prevalent liver disease etiology in both groups (P = 0.96). There was no significant difference in length of stay, readmissions, early complications, or major complications between groups. Vascular and biliary complication rates were similar. Actuarial graft and patient survival at 1, 3, and 5 y were 100/100/100 versus 96/96/96 (P = 0.48). Conclusions. Excellent patient and graft survival is achievable with LT using young pediatric deceased donor grafts in smaller adult recipients. Outcomes are comparable with recipients of age and MELD-matched adult donors. Careful donor MELD-score recipient matching and close monitoring for potential biliary and vascular complications are crucial to achieve acceptable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Recipient Preoperative Characteristicsmentioning

confidence: 99%

Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts

Vargas

Wang

Dalzell

et al. 2022

Transplantation Direct

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“…Grundvoraussetzung für alle Verfahren ist eine vorbestehende regenerative Fähigkeit der Restleber, welche von grundliegender Qualität, Funktion und Durchblutung beeinträchtigt wird. Daher spielt die ALPPS nur begrenzt eine Rolle als Augmentationsverfahren von zirrhotischen Lebern 9 .…”

Section: Posthepatektomie-leberversagenunclassified

“…Daher spielt die ALPPS nur begrenzt eine Rolle als Augmentationsverfahren von zirrhotischen Lebern[9]. ▪ Leberqualität: Primäre Lebertumoren (vor allem das HCC) entstehen häufig auf dem Boden von chronischen Lebererkrankungen.…”

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Operative Therapiestrategien bei primären Lebertumoren, hepatozellulären und Cholangio- inkl. Gallenblasenkarzinomen

Nadalin¹,

Peters²,

Königsrainer³

2022

Allgemein- und Viszeralchirurgie up2date

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“…Numerous studies have shown that caval preservation (CP) in primary LT offers better hemodynamical tolerance, lower blood transfusion requirement, and shorter hospital stay when compared with caval replacement (CR) [2][3][4][5][6][7][8]. In contrast, the technical management of the IVC during late ReLT has not been studied specifically [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Initial piggyback technique facilitates late liver retransplantation – a retrospective monocentric study

et al. 2021

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Optimal management of inferior vena cava (IVC) is crucial to ensure safety in late liver retransplantation (ReLT). The aim of this study was to evaluate different surgical strategies with regard to IVC in late ReLT. All consecutive late ReLT (≥90 days from the previous transplant) from 2013 to 2018 in a single center was reviewed (n = 66). Of them, 46 (69.7%) were performed without venovenous bypass (VVB) including 29 with caval preservation (CP) and 17 with caval replacement (CR). The remaining 20 cases (30.3%) required the use of VVB. Among ReLT without VVB, CP was associated with a lower number of packed red blood cells (median 4 vs. 7; P = 0.016) and a lower incidence of post-transplant acute kidney injury (6.9% vs. 47.1%; P = 0.003). The feasibility of CP was 95% (14/15) in patients with previous 3-vein piggyback caval anastomosis versus 48.3% (15/31) after other techniques (P = 0.003). Indirect signs of portal hypertension (PHT) before retransplantation were predictive of VVB requirement. Early and long-term outcomes were similar across the three groups (CP without VVB, CR without VVB, and VVB). Preserving the IVC in late ReLT is associated with better postoperative renal function and is facilitated by a previous 3-vein piggyback. Routine CR is not justified in late ReLT.

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Comparison of three caval reconstruction techniques in orthotopic liver transplantation: A retrospective review

Cited by 21 publications

References 21 publications

Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts

Outcomes in Adult Liver Transplant Recipients Using Pediatric Deceased Donor Liver Grafts

Operative Therapiestrategien bei primären Lebertumoren, hepatozellulären und Cholangio- inkl. Gallenblasenkarzinomen

Initial piggyback technique facilitates late liver retransplantation – a retrospective monocentric study

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