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01.02.2013 | Original Article | Ausgabe 1/2013

European Surgery 1/2013

Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique and retrograde reperfusion

European Surgery > Ausgabe 1/2013
MD D. Wagner, MD A. Bradatsch, MD D. Kniepeiss, MD S. Schaffellner, MD E. Jakoby, MD H. Müller, MD S. Pirker, MD A. Fahrleitner-Pammer, MD KH. Tscheliessnigg, MD F. Iberer



With an incidence up to 20 % biliary complications in the first year after liver transplantation (LT), these are still the main problems following a successful transplantation (TX). Reperfusion in LT is done via an antegrade flow through the portal vein and the hepatic artery as a standard. Retrograde reperfusion via the caval vein has shown to reduce the rate of initial graft nonfunction after LT but increase biliary complications. Retrograde reperfusion in combination with piggyback technique is the standard technique for liver transplantation in our center. The aim of this study was to compare the rate of biliary complications after LT with retrograde reperfusion in combination with piggyback technique to the literature.


We reviewed our patient records in order to define the rate of biliary complications and patient survival after LT. Patients who were transplanted between 1998 and 2010 were included into the analysis; Ischemic type biliary lesions were defined as the necessity of an endoscopic cholangiography without the placement of a bile duct stent and without evidence of strictures due to anastomosis suture. Kaplan–Meier analysis was performed as time to event (stent) and survival analysis.


One hundred ninety-eight patients were included, median age was 56 (22–71), indications for OLT were cryptogenic (43 %) and viral (40 %) cirrhosis or HCC (17 %). An ERCP was performed in 16 % of the included patients during the first year after LT, 6 % received a bile duct stent. Kaplan–Meier analysis showed a median 1 year survival of 83 % and a median 5 year survival of 73 % in the entire patient population.


Piggyback technique with retrograde reperfusion is a suitable method for LT in our center and did not show a higher prevalence of biliary complications with an excellent patient survival.

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