Piggyback or Cava Replacement: Which Implantation Technique Protects Liver Recipients From Acute Kidney Injury and Complications?

Abstract

The cava-preserving piggyback (PB) technique requires only partial cava clamping during the anhepatic phase in liver transplantation (LT) and, therefore, maintains venous return and may hemodynamically stabilize the recipient. Hence, it is an ongoing debate whether PB implantation is more protective from acute kidney injury (AKI) after LT when compared with a classic cava replacement (CR) technique. The aim of this study was to assess the rate of AKI and other complications after LT comparing both transplant techniques without the use of venovenous bypass. We retrospectively analyzed the adult donation after brain death LT cohort between 2008 and 2016 at our center. Liver and kidney function and general outcomes including complications were assessed. Overall 378 transplantations were analyzed, of which 177 (46.8%) were performed as PB and 201 (53.2%) as CR technique. AKI occurred equally often in both groups. Transient renal replacement therapy was required in 22.6% and 22.4% comparing the PB and CR techniques (P = 0.81). Further outcome parameters including the complication rate were similar in both cohorts. Five-year graft and patient survival were comparable between the groups with 81% and 85%, respectively (P = 0.48; P = 0.58). In conclusion, both liver implantation techniques are equal in terms of kidney function and overall complications following LT.

Graft implantation in liver transplantation ‐ The clock is ticking

“…Accumulated experience with different graft/recipient combinations may provide insight into the subtle aspects of each case that will make it more or less challenging. The choice of caval anastomosis technique, surgical efficiency, preparation of the operative field and awareness of the implications of rWIT all undoubtedly impact the implant time [12]. Although the graft selection is done with the best intent of ideal matching, it is not unusual to encounter grafts that are larger than expected, or a hypertrophied right lobe, which makes the caval anastomosis challenging.…”

Which cava anastomotic techniques are optimal regarding immediate and short‐term outcomes after liver transplantation: A systematic review of the literature and expert panel recommendations

“…The majority of the 18 observational comparative studies 17 , 18 , 19 , 22 , 23 , 31 , 33 , 36 , 40 , 43 , 44 , 48 , 51 , 53 , 54 , 55 , 58 , 59 and two RCTs 5 , 32 demonstrated that the units of PRBCs transfused in the piggyback group was fewer than that of the cava replacement group. No studies demonstrated the units of PRBCs transfused in the cava replacement group was fewer.…”

Clinical Outcomes of Liver Transplantation in Patients With Hepatorenal Syndrome: A Single Center Study in China

“…This may lead to development of renal injury but this suggestion is still controversial. A retrospective study showed that there was no difference of overall recovery of renal function and survival rates among these LT techniques (24). The team suggested that the amount of transfused red blood cells can be used as a predictor because it correlates to the severity of disease and the complexity of the LT surgery.…”