End-to-side caval anastomosis in adult piggyback liver transplantation

Wojciech G. Polak, Balazs A. Nemes, Shungo Miyamoto, Paul M.J.G. Peeters, Koert P. de Jong, Robert J. Porte, Maarten J.H. Slooff

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10 Citations (Scopus)


No consensus exists regarding the optimal reconstruction of the cavo-caval anastomosis in piggyback orthotopic liver transplantation (PB-LT). The aim of this study was to analyze our experience with end-to-side (ES) cavo-cavostomy. Outcome parameters were patient and graft survival and surgical complications. During the period 1995-2002 146 full-size PB-LT in 137 adult patients were performed with ES cavo-cavostomy without the routine use of temporary portocaval shunt (TPCS). In 12 patients (8%) this technique was used for implantation of second or third grafts. Veno-venous bypass was not used in any case and TPCS was performed only in eight patients (6%). One-, three- and five-yr patient and graft survival were 84%, 79% and 75%, and 81%, 74% and 69%, respectively. The median number of intraoperative transfusion of packed red blood cells (RBC) was 2.0 (range 0-33) and 30% of the patients (n = 43) did not require any RBC transfusion. Surgical complications of various types were observed after 49 LT (34%) and none of the complications was specifically related to the technique of ES cavo-cavostomy. Our experience indicates that PB-LT with ES cavo-cavostomy is a safe procedure, can safely be performed without the routine use of a TPCS, has a very low risk of venous outflow obstruction and can also be used effectively during retransplantations.

Original languageEnglish
Pages (from-to)609-616
Number of pages8
JournalClinical Transplantation
Issue number5
Publication statusPublished - Sep 1 2006


  • Adult
  • Caval anastomosis
  • Complications
  • Liver transplantation
  • Outcome
  • Piggyback
  • Surgical technique

ASJC Scopus subject areas

  • Transplantation

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    Polak, W. G., Nemes, B. A., Miyamoto, S., Peeters, P. M. J. G., de Jong, K. P., Porte, R. J., & Slooff, M. J. H. (2006). End-to-side caval anastomosis in adult piggyback liver transplantation. Clinical Transplantation, 20(5), 609-616. https://doi.org/10.1111/j.1399-0012.2006.00525.x