Caval reconstruction techniques in orthotopic liver transplantation

Table 3 Comparison of standard and piggyback technique with and without venovenous bypass

Ref.	Comparison	Results
Tzakis et al[3]	24 piggyback, selective VVB 24 standard, selective VVB	No difference in blood loss, retransplantation rate, portal vein or hepatic artery thrombosis or biliary tract complications
Busque et al[33]	98 piggyback 33 standard, 15% VVB	Attempted piggyback in 131 patients. Were able to complete in 98
Reddy et al[14]	40 standard, routine VVB 36 piggyback, selective VVB	Piggyback associated with shorter anhepatic phase, shorter total operating time, less red blood cell use, trend towards shorter hospital stay, reduced hospital charges
Gerber et al[6]	75 piggyback 127 standard	Piggyback here done with triangular vagotomy at level of right hepatic vein. Decreased operative time, use of blood products, caval complications in piggyback group
Hosein Shokouh-Amiri et al[34]	34 piggyback 56 standard, routine VVB	Piggyback with 60% reduction in anhepatic phase, decreased operative time, higher core body temperature, decrease in fluid, plasma, platelets, RBC volume, 30% shorter ICU stay, hospital stay. Significant reduction in hospital costs
Barshes et al[12]	122 piggyback 98 standard, 76% VVB	Trend towards shorter operating time and ischemia time in piggyback group. Similar amount of blood products transfused. No hepatic vein thrombosis or strictures, no IVC strictures or thrombosis, no hepatic vein obstruction, no anastomotic strictures, no hemorrhagic complications
Nishida et al[35]	918 piggyback, 19.7% VVB 149 standard, 79.2% VVB	Blood transfusion, warm ischemia time, use of VVB were less in piggyback group. Liver, renal function similar
Sakai et al[36]	104 standard, with VVB 148 piggyback, with VVB 174 piggyback, without VVB	Piggyback without VVB required less RBCs, FFP, cryoprecipitate, cell-saver return, less acute renal failure, better patient and graft survival. The piggyback with VVB group had shorter operative time, warm ischemia time, and less acute renal failure than the standard with VVB group
Vieira de Melo et al[37]	125 standard, without VVB 70 piggyback, without VVB	Piggyback group had reduced surgical time, warm ischemia time, red blood cell use, FFP use, mortality at 30 d. No difference in cold ischemia time, length of stay, use of vasoactive drugs in ICU, period of intubation, duration of hospital stay, renal or graft function, need for reoperation, incidence of sepsis, biliary complications, vascular complications, need for retransplantation, 1-yr mortality. Cumulative survival at 1 yr significantly better in PB patients
Cabezuelo et al[38]	84 standard 20 standard with VVB 80 piggyback	Standard technique in comparison to piggyback technique is an independent risk factor for post-operative renal failure. VVB does not ameliorate this effect

VVB: Venovenous bypass; IVC: Inferior vena cava; ICU: Intensive care unit; RBC: Red blood cell; FFP: Fresh frozen plasma; PB: Piggyback.