Results of a newborn liver transplant program in the era of piggyback technique and extended donor criteria in Italy.

The aim of this study was to critically analyze the early and long-term results of a newborn liver transplantation (LTx) centre using piggyback technique (PT) without venovenous bypass and portocaval shunt in the era of extended criteria donors (ECDs). Between 2002 and 2010, a total of 229 LTx were performed in 225 patients, with the shortest as possible cold ischemia time (CIT) policy. The charts of the donors and recipients and the intraoperative data were retrospectively reviewed in order to define the feasibility of PT and surgical outcome, and long-term graft and patient survival. PT feasibility rate was 100%, with a median duration of surgery of 390 min (range 210-630) and median unit of packed RBC transfused intraoperatively of 1 U (range 1-10). Median CIT was 400 min (range 130-870), and median AST peak was 403 mmol/L (range 48-16,900). ECDs graft rate was 85%. Over all primary dysfunction and non-function (PNF) rates were 7.4 and 2.2%, respectively and increased with graft steatosis >30% (P < 0.004). Mortality, morbidity, re-operation and re-LTx rates were 4.4, 25, 6.1 and 1.3%, respectively, and median hospital stay was 18 days (range 8-150). On the long term, graft and patient 5-year overall survival were 72 and 74%, respectively, and re-LTx rate was 0.4%. Survival was significantly affected by recipient HCV-Ab seropositive status (67 vs. 85%, P = 0.023). Liver transplantation can be performed with low morbidity and mortality rates, despite ECDs. PT is a safe and effective procedure that, combined with short CIT, entailed prompt early functional recovery of the grafts and positive long-term results.