Liver transplantation: comparison of the classical orthotopic and piggyback techniques

Zieniewicz, Krzysztof; Krawczyk, Marek; Nyckowski, P; Pawlak, Jacek; Michałowicz, B; Paluszkiewicz, Rafał; Patkowski, Waldemar; Grzelak, I; Alsharabi, A.; Wróblewski, Tadeusz; Smoter, Piotr; Hevelke, Piotr; Remiszewski, Piotr; Skwarek, Anna; Pszenny, C.; Dudek, Krzysztof; Grodzicki, Mariusz

doi:10.1016/s0041-1345(01)02867-6

Cited by 15 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With respect to the operation time, the mean duration in our cases was 326 minutes; this is an acceptable result in comparison with previous MPB studies (range: 449‐708 minutes)22, 34, 49–51 (Table 6). Moreover, the overall median anastomosis time of our cases was 108 minutes for all 3 vascular anastomoses, with a mean cavocaval anastomosis duration of 12 minutes.…”

Section: Discussionsupporting

confidence: 88%

“…On the other hand, the avoidance of venous congestion in the lower half of the body and retrocaval dissection along with fewer vascular anastomoses helped to reduce the overall blood loss. According to our study, the median intraoperative blood loss, units of packed RBCs, and units of FFP were 1500 mL, 2.0, and 12.0, respectively, and they were within an acceptable range (blood loss: 800‐3400 mL; RBC transfusion: 10.8‐12.4 U; and FFP transfusion: 21‐26 U) of other experiences20, 22, 26, 34, 49–51 (Table 6). Furthermore, moderate intraoperative blood loss and less packed RBC and FFP replacement in our cases could explain the cardiodynamic stability during the anhepatic phase, which is especially important in patients with marginal cardiovascular reserve 10.…”

Section: Discussionsupporting

confidence: 87%

“…Renal failure due to cardiovascular instability, IVC cross‐clamping, and severe intraoperative blood loss, which are important postoperative concerns in LTx, is low among patients undergoing MPB transplantation. In our series, 6.2% of the patients had postoperative renal failure; this is within the reported rate in other case series (0%‐16.7%) 17, 22, 49, 51, 53, 54. In a comparative study, Hesse et al22 showed that the incidence of early postoperative renal dysfunction was significantly lower in the MPB group because of the shorter operative time and lesser need for IVC cross‐clamping in comparison with the standard PB technique 22.…”

Section: Discussionmentioning

confidence: 99%

“…As published, the MPB technique allows better intraoperative recipient hemodynamics, low intraoperative blood loss, reduced surgical time and cost of surgery, a low incidence of renal failure, and a diminished risk of deep venous thrombosis 12, 22, 49. Moreover, the need for VVB is also significantly lower than in PB or conventional LTx 12, 21, 22.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

View full text Add to dashboard Cite

Head and neck squamous cell carcinoma (HNSCC) is one of many cancers that are strongly associated with tobacco use. Whereas HNSCC is often seen in tobacco users, many tobacco users do not develop carcinoma; and the differences between smokers with and without HNSCC are poorly studied to date. Some smokers may be inherently more susceptible to developing carcinoma due to patterns of tobacco use, innate metabolism of carcinogens, or altered excretion. Identifying those smokers at greatest risk for HNSCC would have great benefit through targeted smoking cessation efforts and enhanced surveillance. One approach to better understand the extent of exposure to, and metabolism of, tobacco carcinogens is through the use of tobacco-specific metabolites. Tobacco-specific metabolites can identify patterns of dose, exposure, and metabolism, and perhaps ultimately characterize the important differences between smokers who develop HNSCC and smokers who do not.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

2011

View full text Add to dashboard Cite

show abstract

“…22,23 This simpler and faster anastomosis may be associated with decreased intraoperative bleeding, decreased blood product transfusion, and decrease in partial clamping of the inferior vena cava, and it has become a preferred technique by some centers. 7,19,[24][25][26][27] The experience with this technique likely decreased operative time after phase 1 (Table 3), but this could not be confirmed with statistical testing because of small number of transplants in phase 1.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

View full text Add to dashboard Cite

A single-center experience of 500 liver transplants using the modified piggyback technique by Belghiti

et al. 2009

View full text Add to dashboard Cite

Over the past 4 decades, the surgical techniques of liver transplantation (LTx) have permanently evolved and been modified. Among these, the modified piggyback (MPB) technique by Belghiti offers specific advantages. The objective of this study was to present our single-center experience with the MPB technique in 500 cases. Recipients' perioperative data were prospectively collected and evaluated. Postoperative and specific complications, stay in the intensive and intermediate care unit, and the mortality rate with cause of death were analyzed. Most recipients were classified as Child C (49.1%). For the patients who underwent LTx for the first time, alcoholic (23.9%) and viral (22.2%) cirrhosis and hepatocellular carcinoma (15.1%) were the prevalent indications. The overall median warm ischemia time, anastomosis duration, and operative time were 45, 108, and 320 minutes, respectively. The median intraoperative blood loss was 1500 mL. A venovenous bypass was never needed to maintain hemodynamic stability. Only in a few cases was temporary inferior vena cava clamping necessary. Most prominent surgical complications were hemorrhage, hematoma, and wound dehiscence. Renal failure occurred in 6.2% of patients. The overall median stay in the intensive and intermediate care unit was 14 days. The mortality rates within 30 and 90 days were 6.3% and 13.3%, respectively. No technique-related death occurred. The MPB technique by Belghiti is a feasible and simple LTx technique. The caval flow is preserved during the anhepatic phase, and this minimizes the need for venovenous bypass or portocaval shunt. This technique requires only 1 caval anastomosis, which is easy to perform with a short anhepatic phase. To minimize the risk of outflow obstruction, attention should be paid by doing a wide cavocavostomy cranially to the donor inferior vena cava in a door-lock manner. This technique can be applied in almost all patients undergoing LTx for the first time and liver retransplantation as well. Liver Transpl 15: 466-474, 2009. © 2009 AASLD. Received December 9, 2007 accepted November 15, 2008. Liver transplantation (LTx) is a well-known and widely applied procedure for the treatment of end-stage liver diseases. Over the past 4 decades, the surgical techniques of LTx have permanently evolved and been modified.1 Conventional LTx with total hepatectomy and resection of the recipient retrohepatic inferior vena cava (IVC) and interposition of the donor IVC attached to the new graft was described by Starzl et al. 2 in 1963. In this procedure, during the anhepatic phase, there is a substantial decrease in venous backflow to the heart, causing hemodynamic instability, metabolic alterations, and reduction in renal flow.3 In contrast to the conventional technique, Calne and Williams 4 in 1968 reported a technique that was popularized in 1989 by Tzakis et al. 5 as the so-called piggyback (PB) technique. This technique includes hepatectomy with preservation of the recipient retrohepatic vena cava to maintain the venous return to the heart...

show abstract

Liver transplantation: comparison of the classical orthotopic and piggyback techniques

Cited by 15 publications

References 9 publications

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

Tobacco carcinogen metabolites and DNA adducts as biomarkers in Head and Neck cancer: Potential screening tools and prognostic indicators

Untitled

A single-center experience of 500 liver transplants using the modified piggyback technique by Belghiti

Contact Info

Product

Resources

About