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The Piggyback Liver Transplant Procedure

written by: suzysnowflake • edited by: Emma Lloyd • updated: 7/27/2010

The piggyback liver transplant is different from traditional orthotopic transplant in that it leaves the patient’s vena cava in place. Many doctors are seeing the advantage to perform the piggyback method. No matter what method is used, the liver transplant waiting list procedure remains the same.

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    Liver transplantation is only considered when the liver is no longer able to function adequately. Liver transplants are the second most common organ transplants after kidney transplants. The most common kind of liver transplant is called an orthotopic transplant. However, the piggyback liver transplant is becoming more common.

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    What is a Piggyback Transplant?

    The traditional kind of liver transplant is called an orthotopic transplant, where the entire liver is removed and replaced with a donor liver. In the piggyback method, most of the patient’s liver is removed, but the vena cava is left behind. The vena cava is then grated to the donor liver. The vena cava is a large vein that returns blood to the heart from the abdominal organs (including the liver) and the lower limbs. This transplant technique can be performed on most persons having a liver transplant.

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    How to Prepare for a Piggyback Transplant

    Preparation for a piggyback liver transplant is the same preparation as undergoing an orthotopic transplant. First, the doctor must believe the patient is a viable candidate for a transplant and arrange for them to be evaluated by a transplant team. The transplant team has a coordinator, a liver specialist (hepatologist), and a transplant surgeon. The patient may also see other specialists depending on their health, and might meet with a psychiatrist since the transplant process can be extremely emotional. A social worker might be involved with the transplant team to offer a support system.

    Several tests are run on the patient to determine the extent of liver disease. These tests may include blood and urine tests, liver ultrasound, cardio tests, a physical, and psychological evaluation. Financial and social analyses are also done to determine if the patient can afford the transplant and that they have a social network to assist them.

    Once all the testing is done, a review committee evaluates the patient’s data to determine eligibility to receive a transplant. If they are accepted into the transplant program, they are placed on a waiting list. Patients that are more critical are higher on the list. How long the patient has to wait for the transplant depends on their placement on the list. Patients then await the call that they are ready for a transplant. As of 2009, over 16,000 patients were on the liver waiting list.

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    • Red blood cell requirements are reduced
    • Prevents severe hemodynamic instability by reducing the need for vasoactive drugs
    • Increased survival rate
    • Decreased complications
    • Avoids congestion in the legs and kidneys which lead to early postoperative renal failure
    • Minimal bleeding and more stable internal environment
    • Shortened ICU and hospital stay
    • Veno-venous bypass is avoided
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    • Patients with several portal hypertension cannot undergo piggyback procedure
    • Patients with hepatocellular carcinoma cannot have procedure
    • Longer operation time
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    Patients undergoing this procedure spend less time in intensive care and in the hospital recovering than those who underwent traditional liver transplant methods. They also have longer survival rates. Because of the reduced hospital stays, the cost to the patient is also less.

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    This type of transplant is a viable alternative to traditional liver transplant procedures. For those on the transplant waiting list, it should be an option that the patient considers with their doctor.