Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Inferior vena cava

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    Back Table Procedure for the Modified Piggyback Technique of Liver Transplantation: A Simple Test To Identify Caval Leaks on the Bench
    (Başkent Üniversitesi, 2004-12) Orug, Taner; Jarufe, Nicolas; Soonawalla, Zahir; Tekin, Koray; Mirza, Darius F.; Mayer, David
    Objectives: In October 2001, we elected to change from the standard orthotopic liver transplantation procedure to the modified piggyback technique with side-to-side cavo-cavostomy, and to document complications such as caval leaks prospectively. Failure to identify and ligate caval tributaries during bench preparation of liver allografts results in troublesome hemorrhage after reperfusion. After our experience with the first 30 piggybacks, we introduced a simple leak test to resolve this problem. Materials and Methods: The leak test consists of inflating the inferior vena cava with preservation solution via the infrahepatic inferior vena cava after closure of the suprahepatic inferior vena cava at the end of the bench procedure. Between October 2001 and July 2002, 112 whole liver transplants were performed in 108 adults. Standard orthotopic liver transplantation (group 1) was performed in 25, modified piggyback without leak test (group 2) was performed in 30, and modified piggyback after leak test (group 3) was performed in 57 patients. The incidence of caval leaks before and after introduction of the test was compared using the chi-square test. Results: Nine patients in group 1 (36%) and 13 in group 2 (43%) required additional sutures to control bleeding from caval branches after reperfusion. In group 3, the leak test identified caval tributaries that required ligation in 20 livers (35%) before implantation; none bled after reperfusion. Of the 37 cases with negative leak test results, 3 (8%) subsequently bled from missed caval branches. Sensitivity, specificity, and accuracy for the leak test were 100%, 92.1%, and 94.7% respectively. Conclusions: Nearly all small branches of the inferior vena cava can be successfully identified during the back table procedure by performing a leak test.
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    Reconstruction of the Hepatic Venous Outflow in Piggyback Liver Transplantation
    (Başkent Üniversitesi, 2004-06) Barshes, Neal R; Lee, Timothy; Kılıç, Murat; Goss, John A
    Objectives: The “piggyback” hepatic vein reconstruction and orthotopic liver transplantation (PBOLT) is a technique of liver transplantation that leaves the recipient inferior vena cava (IVC) intact, often avoiding the use of venovenous bypass (VVBP). Our study investigated whether patient morbidity and mortality after PB-OLT was comparable to that of the standard technique of orthotopic liver transplant (STD-OLT), which generally requires VVBP. Materials and Methods: We reviewed 220 consecutive adult OLTs performed at a single institution. In the PB-OLT technique, the IVC was left intact. The suprahepatic IVC was anastomosed to a cuff, fashioned from the confluence of the recipient left and middle hepatic veins. The donor infrahepatic IVC was oversewn. The STD-OLT technique was used when patient conditions precluded PB-OLT. VVBP was required in 83% of STD-OLT cases and no cases of PB-OLT.