Widmer, JD;
Schlegel, A;
Ghazaly, M;
Davidson, BR;
Imber, C;
Sharma, D;
Malago, M;
(2018)
Piggy-back or cava replacement - which implantation technique protects liver recipients from acute kidney injury and complications.
Liver Transplantation
10.1002/lt.25334.
(In press).
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Abstract
The cava-preserving piggyback technique requires only partial cava clamping during anhepatic phase in liver transplantation (LT) and therefore maintains venous return and may hemodynamically stabilize the recipient. Hence, it is an on-going debate, if piggy-back implantation is more protective from acute kidney injury (AKI) after LT when compared to classic cava replacement technique. The aim of this study was therefore to assess the rate of AKI and other complications after LT comparing both transplant techniques without the use of veno-venous bypass. We retrospectively analyzed the adult DBD liver transplant cohort between 2008 - 2016 at our center. Liver and Kidney function, and general outcome including complications were assessed. Overall 378 transplantations were analyzed, of which 177 (46.8%) were performed as piggy-back and 201 (53.2%) as cava replacement technique. AKI occurred equally often in both groups. Transient renal replacement therapy was required in 22.6% and 22.4% comparing piggy-back and cava replacement technique (p=.81). Further outcome parameters including complication rate were similar in both cohorts. Five-year graft and patient survival was comparable between the groups with 81% and 85%, respectively (p=.48; p=.58). In conclusion, both liver implantation techniques are equal in terms of kidney function and overall complications following liver transplantation.
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