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Khajeh E, Ramouz A, Aminizadeh E, Sabetkish N, Golriz M, Mehrabi A, Fonouni H. Comparison of the modified piggyback with standard piggyback and conventional orthotopic liver transplantation techniques: a network meta-analysis. HPB (Oxford) 2023:S1365-182X(23)00071-0. [PMID: 37120378 DOI: 10.1016/j.hpb.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND In conventional orthotopic liver transplantation (OLT), the recipient's retrohepatic inferior vena cava (IVC) is completely clamped and replaced with the donor IVC. The piggyback technique has been used to preserve venous return, either via an end-to-side or standard piggyback (SPB), or via a side-to-side or modified piggyback (MPB) anastomosis, using a venous cuff from the recipient hepatic veins with partially clamping and preserves the recipient's inferior vena cava. However, whether these piggyback techniques improve the efficacy of OLT is unclear. To address the low quality of the available evidence, we performed a meta-analysis to compare the efficacy of conventional, MPB, and SPB techniques. METHODS Literature was searched in Medline and Web of Science databases for relevant articles published until 2021 without any time restriction. A Bayesian network meta-analysis was performed to compare the intra- and postoperative outcomes of conventional OLT, MPB, and SPB techniques. RESULTS Forty studies were included, comprising 10,238 patients. MPB and SPB had significantly shorter operation times and fewer transfusions of red blood cell and fresh frozen plasma than conventional techniques. However, there were no differences between MPB and SPB in operation time and blood product transfusion. There were also no differences in primary non-function, retransplantation, portal vein thrombosis, acute kidney injury, renal dysfunction, venous outflow complications, length of hospital and intensive care unit stay, 90-day mortality rate, and graft survival between the three techniques. CONCLUSION MBP and SBP techniques reduce the operation time and need for blood transfusion compared with conventional OLT, but postoperative outcomes are similar. This indicates that all techniques can be implemented based on the experience and policy of the transplant center.
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Affiliation(s)
- Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ehsan Aminizadeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Nastaran Sabetkish
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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Maria Silva A, Reis Waisberg D, Ribeiro Fernandes M, Martino RB, Rocha-Santos V, Pinheiro RS, Nacif LS, Arantes RM, Ducatti L, Galvão FH, Lee AD, Haddad LB, Silva NA, Dala Riva DF, Moreira AM, Oliveira RA, Carnevale FC, Andraus W, Carneiro-D Albuquerque LA. Hepatic Venous Outflow Obstruction in Adult Deceased Donor Liver Transplantation: Classic Piggyback Implantation Versus a Modified Technique that Widens the Ostium of the Recipient's Left and Middle Hepatic Veins. Transplant Proc 2022; 54:1316-1319. [PMID: 35659781 DOI: 10.1016/j.transproceed.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The classic piggyback technique uses the union of the 3 hepatic veins to perform the cavo-caval anastomosis. However, due to the lateral localization of the right hepatic vein, the partial clamping of the vena cava in this technique significantly reduces the venous return to the right atrium. To avoid this, we adopted in 2015 a modified piggyback technique, in which we use the common trunk of the middle and left hepatic veins and also perform a lateral incision toward the right in the anterior wall of the vena cava in order to widen the final ostium of the cavo-caval anastomosis. The aim of the study was to analyze the incidence of hepatic venous outflow obstruction between those 2 techniques. METHODS Retrospective study of liver transplant recipients undergoing venography for suspected hepatic venous outflow obstruction from January 2009 to June 2021. Patients undergoing transplantation with living donors or split grafts and pediatric cases were excluded from the study. RESULTS From January 2009 to December 2014 and from January 2015 to June 2021, 587 (group 1) and 730 (group 2) deceased-donor liver transplants were performed with the classic and the modified piggyback techniques, respectively. The incidence of cases with suspected hepatic venous outflow obstruction in groups 1 and 2 were 1.87% (n = 11) and 0.95% (n = 7), respectively (P = 0,15). The number of confirmed patients with outflow blockage that required endovascular treatment during venography in groups 1 and 2 were 4 (0.68%) and 5 (0.68%), respectively (P = 0,31). CONCLUSIONS This modified piggyback technique did not increase the incidence of hepatic venous outflow obstruction at our service.
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Affiliation(s)
- Amanda Maria Silva
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Michel Ribeiro Fernandes
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Rodrigo Bronze Martino
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Rafael Soares Pinheiro
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Lucas Souto Nacif
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Rubens Macedo Arantes
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Flávio Henrique Galvão
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil; Laboratory of Medical Investigation 37, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Andre Dong Lee
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Luciana Bertocco Haddad
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil; Laboratory of Medical Investigation 37, University of Sao Paulo Medical School, Sao Paulo, Brazil; Interventional Radiology Division, Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Nataliê Almeida Silva
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Daniel Fernandes Dala Riva
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Airton Mota Moreira
- Interventional Radiology Division, Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Ricardo Abdala Oliveira
- Interventional Radiology Division, Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Francisco César Carnevale
- Interventional Radiology Division, Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Wellington Andraus
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil; Laboratory of Medical Investigation 37, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Luiz Augusto Carneiro-D Albuquerque
- Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil; Laboratory of Medical Investigation 37, University of Sao Paulo Medical School, Sao Paulo, Brazil
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