OBJECTIVE: The objective of this study was to describe the complications specifically related to orthotopic liver transplantation (OLT) with preservation of the inferior vena cava and to their therapeutic management. This preservation technique has considerably influenced the surgical phases of liver transplantation, increasing hepatectomy time and modifying the number of vascular anastomoses. METHODS: Our retrospective multicentric study, based on data from 1361 adult patients that had undergone orthotopic liver transplantation with preservation of the inferior vena cava in France between 1991 and 1997, analyzed the concomitant surgical complications. Type of cavo-caval anastomosis performed (piggyback, end-to-side, or side-to-side), use of a temporary portacaval anastomosis, technique-related complications, and mortality, were investigated. RESULTS: Cavo-caval anastomosis was side-to-side in 50.6% of cases (n=689), piggyback in 42.7% (n=582), and end-to-side in 6.6% (n=90). In total, 882 temporary portacaval anastomosis were carried out. Fifty-five patients presented with one or more complications related to the preservation of the inferior vena cava technique; i.e., overall morbidity was 4.1% (55/1361). Overall mortality was 0.7% (10/1361). Mortality rate for patients who presented with surgical complication was 18%. A total of 64 complications were recorded: 57 (89%) were in the perioperative or immediate postoperative period and 7 (11%) were postoperative. CONCLUSIONS: These retrospective, descriptive results show significant advantages in favor of side-to-side anastomosis in terms of vascular complications. Certain factors should be evaluated specifically at pretransplant assessment to prevent certain serious complications; principally, these are anatomic factors of the recipient (inferior vena cava included in segment I, anatomic abnormalities of the inferior vena cava) and graft size. Depending on these factors, surgeons must be able to adapt the orthotopic liver transplantation, either before or during orthotopic liver transplantation, preferring the standard technique.
OBJECTIVE: The objective of this study was to describe the complications specifically related to orthotopic liver transplantation (OLT) with preservation of the inferior vena cava and to their therapeutic management. This preservation technique has considerably influenced the surgical phases of liver transplantation, increasing hepatectomy time and modifying the number of vascular anastomoses. METHODS: Our retrospective multicentric study, based on data from 1361 adult patients that had undergone orthotopic liver transplantation with preservation of the inferior vena cava in France between 1991 and 1997, analyzed the concomitant surgical complications. Type of cavo-caval anastomosis performed (piggyback, end-to-side, or side-to-side), use of a temporary portacaval anastomosis, technique-related complications, and mortality, were investigated. RESULTS: Cavo-caval anastomosis was side-to-side in 50.6% of cases (n=689), piggyback in 42.7% (n=582), and end-to-side in 6.6% (n=90). In total, 882 temporary portacaval anastomosis were carried out. Fifty-five patients presented with one or more complications related to the preservation of the inferior vena cava technique; i.e., overall morbidity was 4.1% (55/1361). Overall mortality was 0.7% (10/1361). Mortality rate for patients who presented with surgical complication was 18%. A total of 64 complications were recorded: 57 (89%) were in the perioperative or immediate postoperative period and 7 (11%) were postoperative. CONCLUSIONS: These retrospective, descriptive results show significant advantages in favor of side-to-side anastomosis in terms of vascular complications. Certain factors should be evaluated specifically at pretransplant assessment to prevent certain serious complications; principally, these are anatomic factors of the recipient (inferior vena cava included in segment I, anatomic abnormalities of the inferior vena cava) and graft size. Depending on these factors, surgeons must be able to adapt the orthotopic liver transplantation, either before or during orthotopic liver transplantation, preferring the standard technique.
Authors: Murat Cag; Maxime Audet; Anne-Catherine Saouli; Murad Odeh; Bernard Ellero; Tullio Piardi; Marie-Lorraine Woehl-Jaeglé; Jacques Cinqualbre; Philippe Wolf Journal: Hepatol Int Date: 2011-02-17 Impact factor: 6.047
Authors: Carlo Ferro; Enzo Andorno; Andrea Guastavino; Umberto G Rossi; Sara Seitun; Giulio Bovio; Umberto Valente Journal: Radiol Med Date: 2013-12-20 Impact factor: 3.469
Authors: Giuseppe Maria Ettorre; Roberto Santoro; Giovanni Vennarecci; Pasquale Lepiane; Mario Antonini; Eugenio Santoro Journal: Updates Surg Date: 2011-07-19
Authors: M Hosein Shokouh-Amiri; A Osama Gaber; W A Bagous; H P Grewal; D K Hathaway; S R Vera; R J Stratta; T N Bagous; T Kizilisik Journal: Ann Surg Date: 2000-06 Impact factor: 12.969
Authors: Seigo Nishida; Noboru Nakamura; Anil Vaidya; David M Levi; Tomoaki Kato; Jose R Nery; Juan R Madariaga; Enrique Molina; Phillip Ruiz; Anthony Gyamfi; Andreas G Tzakis Journal: HPB (Oxford) Date: 2006 Impact factor: 3.647