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TRANSCRIPT
ILTS
2018 Poster presented
at:
Jeannette D. Widmer1, Andrea Schlegel2, Mohamed Ghazaly1, Brian Richie Davidson1, Charles Imber1, Dinesh Sharma1, Massimo Malago1, Joerg-Matthias Pollok1
Piggy-back or Cava Replacement: Which Technique is Protective against Acute Kidney Injury
after Liver Transplantation?
1 HPB Surgery and Liver Transplantation, Royal Free Hospital London, United Kingdom, 2 Department of Liver Surgery, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
Introduction• Piggy-back (PB) technique requires partial, cava
replacement (CR) technique total cava clamping during anhepatic phase in liver transplantation (LT).
• It is an on-going debate, if PB implantation is more protective from acute kidney injury due to continuous
venous return when compared to CR technique.
Piggy-back Cava Replacement
Methods
Results
No significance
Acute kidney injury?
ObjectivesTo assess the rate of AKI and other complications after LT comparing both transplant techniques without the use of
veno-venous bypass.
• 378 patients with liver transplantation from DBD donors• Between 2008 – 2016 at Royal Free Hospital, London• 177 piggy-back (47%) and 201 (53%) cava replacement technique• Kidney function assessment 5 days, 3 and 12 months• Overall follow-up was 4 years
• A p-value of <0.05 was considered to be statistically significant• Statistical Analysis was carried out using IBM® SPSS® v.24, prism v.5
Conclusions• No difference in terms of short- and long-term kidney
function• Only MELD impacts on post-transplant renal replacement
therapy• No difference in complication rate• Piggy-back with shorter WIT, less blood products
1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline forAcute Kidney Injury. Kidney Int Suppl. 2012;2(1):1-138.
2. Grande L, et al. Effect of venovenous bypass on perioperative renal function in liver transplantation: results of a randomized,controlled trial. Hepatology. 1996;23(6):1418-1428.
3. Khosravi MB, et al. The Effect of Clamping of Inferior Vena Cava and Portal Vein on Urine Output During LiverTransplantation. Transplant Proc. 2007;39(4):1197-1198.
4. Brescia M, Massarollo P, Imakuma E, Mies S. Prospective randomized trial comparing hepatic venous outflow and renalfunction after conventional versus piggyback liver transplantation. PLoS ONE [Electronic Resour. 2015;10(6).
References
P-144Jeannette Widmer DOI: 10.3252/pso.eu.ILTS2018.2018
Outcomes / Complications