Abstract
Background
In conventional orthotopic liver transplantation (OLT), the recipient's retrohepatic
inferior vena cava (IVC) is completely clamped and replaced with the donor IVC. The
piggyback technique has been used to preserve venous return, either via an end-to-side
or standard piggyback (SPB), or via a side-to-side or modified piggyback (MPB) anastomosis,
using a venous cuff from the recipient hepatic veins with partially clamping and preserves
the recipient's inferior vena cava. However, whether these piggyback techniques improve
the efficacy of OLT is unclear. To address the low quality of the available evidence,
we performed a meta-analysis to compare the efficacy of conventional, MPB, and SPB
techniques.
Methods
Literature was searched in Medline and Web of Science databases for relevant articles
published until 2021 without any time restriction. A Bayesian network meta-analysis
was performed to compare the intra- and postoperative outcomes of conventional OLT,
MPB, and SPB techniques.
Results
Forty studies were included, comprising 10,238 patients. MPB and SPB had significantly
shorter operation times and fewer transfusions of red blood cell and fresh frozen
plasma than conventional techniques. However, there were no differences between MPB
and SPB in operation time and blood product transfusion. There were also no differences
in primary non-function, retransplantation, portal vein thrombosis, acute kidney injury,
renal dysfunction, venous outflow complications, length of hospital and intensive
care unit stay, 90-day mortality rate, and graft survival between the three techniques.
Conclusion
MBP and SBP techniques reduce the operation time and need for blood transfusion compared
with conventional OLT, but postoperative outcomes are similar. This indicates that
all techniques can be implemented based on the experience and policy of the transplant
center.
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Article info
Publication history
Published online: March 13, 2023
Accepted:
February 27,
2023
Received:
July 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc.
