Advantages of the piggy back technique on intraoperative transfusion, fluid compsumption, and vasoactive drugs requirements in liver transplantation: a comparative study

The piggyback technique was first described in adult liver transplantation in 1989, although it has been used in conjuction with venous bypass, with cross-clamping the vena cava, or both. In this study, the inferior vena cava was not occluded at any time during the liver transplant. We compared the use of intraoperative blood products, fluid requirements, and vasoactive drugs among patients managed with bypass, without bypass, and with the piggyback technique. Between May 1986 and October 2002, 875 liver transplants included 50 patients divided into three groups (cases considered to be the preliminary series on each group): group A/piggyback (17 patients:34%), group B/ bypass (16 patients: 32%), and group C/no bypass (17 patients:34%). There were no differences in mean age, gender, UNOS or Child-Pugh score, and indications for liver transplantation. Mean follow up was 134.63 ± 32.19 months. At the end of the study, 91.3% of the patients are alive with no operative mortality. There were no differences in postoperative complications, postreperfusion syndrome rate, and postoperative renal failure. However, the number of packed red blood cell units consumed intraoperatively (12 ± 7.43 vs 18.03 ± 11.46 vs 17.59 ± 23.8; P = .043), the need for intraoperative crystaloids (3.1 L ± 1.6 vs 6.8 ± 4.8 vs 9.1 L ± 3.6; P = .001) and the requirement for vasoactive drugs (18% vs 38% vs 24%; P = .043) was notably lower in group A vs group B vs group C. Operative time was longer in group A (121.54 ± 37.77 vs 78.73 ± 11.89 vs 87.07 ± 14.33 minutes) The piggyback technique requires a longer operative time but offers the advantages of reducing the red blood cell requirements and preventing severe hemodynamic instability by virtue of reducing the need for vasoactive drugs and for a larger volume of intraoperative fluids.