Abstract
361 Background: The piggyback technique with caval preservation has evolved to avoid venovenous bypass and is required during living donor liver transplantation. We determined the impact of the piggyback technique during OLT on surgical outcome and resource utilization at our institution. Methods: Between 12/1/93 and 12/1/98, 184 patients underwent primary OLT. 114 patients (62%) underwent cavo-caval anastomosis (CCA) while 70 patients (38%) underwent piggyback (PGB) technique with caval preservation. All patients received immunosuppression with steroid taper and tacrolimus or cyclosporin. Surgical morbidity and mortality, intensive care unit (ICU) and hospital length of stay (LOS), blood product usage, and need for venovenous (V/V) bypass were evaluated. Results. Patients were stratified by surgical technique (CCA vs. PGB, respectively) and had similar mean age (47.7 vs. 47.8), Child's score (10.0 vs. 9.7), UNOS status (2.3 vs. 2.3), and serum creatinine (1.52 vs. 1.43) preoperatively. 30 day operative mortality was not significantly different (14% vs. 10%) between groups. V/V bypass was used in 86% of CCA and 0% of PGB cases (p<0.0001, Fisher's Exact Test). Intraoperative hypotension (SBP < 80mmHg for ≥ 15 minutes) was encountered more frequently during CCA than PGB technique (11.4% vs. 2.9%, p≤0.05). No differences were seen in the frequency of intraoperative arrhythmia's, hypoxemia, cardiac failure or arrest, or total and warm ischemia times. (Table) One and three year survival were 74% vs. 88% and 62% vs. 83%, CCA vs. PGB respectively (p=0.0152 by Log Rank test).TableConclusions: Caval preservation is a surgical innovation which is safe and effective and has become our standard procedure during OLT. Avoidance of venovenous bypass and improved intraoperative hemodynamics may result in reduced postoperative morbidity and mortality. Reductions in ICU and hospital length of stay result in less hospital costs while improving patient outcome.
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