Hepatic outflow study after piggyback liver transplantation

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Vascular anastomosis

Background:

• Hepatic vein outflow is critical in liver transplantation, particularly when preserving the recipient retrohepatic vena cava (RHVC).
• Evaluating suprahepatic caval anastomosis techniques is essential for optimizing outcomes.

Purpose of the Study:

• To compare two distinct methods of suprahepatic caval anastomosis in liver transplant recipients.
• To assess the impact of different anastomosis techniques on hepatic venous outflow and pressure gradients.

Main Methods:

• A comparative study involving 81 liver transplant recipients (88 transplants) between 1993 and 1995.
• Group 1 (52 patients): Suprahepatic caval anastomosis between graft and recipient hepatic vein ostia.
• Group 2 (30 patients): Associated 3 cm vertical cavotomy with partial clamping of RHVC. Postoperative pressure and gradient measurements were performed.

Main Results:

• Mean pressure gradient between hepatic veins and right atria was significantly lower in Group 1 (0.75 mmHg) vs. Group 2 (2.06 mmHg).
• Hemodynamically significant pressure gradients (>3 mmHg) were observed in 10% of Group 1 vs. 40% of Group 2 patients (p=0.03) between hepatic veins and right atria.
• No significant difference in pressure gradients was found between RHVC and right atria (p=0.3).

Conclusions:

• Preservation of the recipient RHVC with anastomosis at the median and left hepatic vein ostia is a reliable technique.
• This method ensures no hepatic venous outflow alteration, rendering associated cavotomy unnecessary.