06 September 2013
The impact of surgical technique on the results of liver transplantation in patients with hepatocellular carcinoma
Michał GrątABCDEF, Oskar KornasiewiczDF, Zbigniew LewandowskiCDE, Michał SkalskiBF, Krzysztof ZieniewiczDEF, Leszek PączekBD, Marek KrawczykADEFGDOI: 10.12659/AOT.884005
Ann Transplant 2013; 18:448-459
Abstract
Background
Although piggyback technique has gained widespread acceptance for liver transplantation in general, there is an exceptional lack of data on the choice of appropriate surgical technique for patients with hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the impact of surgical technique on outcomes after liver transplantation for HCC.
Material and Methods
We conducted a retrospective cohort study on 90 HCC patients who underwent liver transplantation with the conventional (n=19) or piggyback (n=71) technique. Both techniques were compared with respect to intraoperative variables and long-term outcomes, determined by 3-year overall (OS) and recurrence-free (RFS) survival. The potential role of confounding factors was excluded in a series of Cox proportional regression models.
Results
The piggyback technique was associated with shorter procedure duration (p=0.0005), shorter anatomical anhepatic phase (p<0.0001), shorter duration of total (p=0.018) and warm ischemia (p<0.0001), and fewer blood transfusions (p=0.006). Three-year OS was 89.1% after piggyback and 49.9% after conventional transplantation (p=0.0008), with 3-year RFS of 89.4% and 56.0% (p=0.0006), respectively. Piggyback transplantations provided outcomes superior to conventional procedures both in patients within (p=0.019 for OS; p=0.003 for RFS) and beyond (p=0.023 for OS; p=0.031 for RFS) Milan criteria. Multivariate analysis of the risks of death and recurrence confirmed the benefits of piggyback technique.
Conclusions
Given its superior long-term outcome, piggyback transplantation might be considered primarily for HCC patients.
Keywords: Liver Transplantation, Hepatocellular carcinoma (HCC), Neoplasm recurrence, surgical technique, outcomes, piggyback technique
In Press
Original article
Impact of Preoperative Treatment on Donor Hepatic Steatosis in Living Donor Liver TransplantationAnn Transplant In Press; DOI: 10.12659/AOT.947772
Original article
Effects of Donor-Recipient Race Matching on Kidney Transplant SurvivalAnn Transplant In Press; DOI: 10.12659/AOT.947720
Most Viewed Current Articles
03 Jan 2023 : Original article 6,996
Impact of Autologous Stem Cell Transplantation on Primary Central Nervous System Lymphoma in First-Line and...DOI :10.12659/AOT.938467
Ann Transplant 2023; 28:e938467
15 Aug 2023 : Review article 6,986
Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ TransplantationDOI :10.12659/AOT.939750
Ann Transplant 2023; 28:e939750
16 May 2023 : Original article 6,742
Breaking Antimicrobial Resistance: High-Dose Amoxicillin with Clavulanic Acid for Urinary Tract Infections ...DOI :10.12659/AOT.939258
Ann Transplant 2023; 28:e939258
28 May 2024 : Original article 6,162
Effect of Dexmedetomidine Combined with Remifentanil on Emergence Agitation During Awakening from Sevoflura...DOI :10.12659/AOT.943281
Ann Transplant 2024; 29:e943281