{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:53:51Z","timestamp":1768877631682,"version":"3.49.0"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2009,5,1]],"date-time":"2009-05-01T00:00:00Z","timestamp":1241136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2009,4,27]],"date-time":"2009-04-27T00:00:00Z","timestamp":1240790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,5]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Over the past 4 decades, the surgical techniques of liver transplantation (LTx) have permanently evolved and been modified. Among these, the modified piggyback (MPB) technique by Belghiti offers specific advantages. The objective of this study was to present our single-center experience with the MPB technique in 500 cases. Recipients' perioperative data were prospectively collected and evaluated. Postoperative and specific complications, stay in the intensive and intermediate care unit, and the mortality rate with cause of death were analyzed. Most recipients were classified as Child C (49.1%). For the patients who underwent LTx for the first time, alcoholic (23.9%) and viral (22.2%) cirrhosis and hepatocellular carcinoma (15.1%) were the prevalent indications. The overall median warm ischemia time, anastomosis duration, and operative time were 45, 108, and 320 minutes, respectively. The median intraoperative blood loss was 1500 mL. A venovenous bypass was never needed to maintain hemodynamic stability. Only in a few cases was temporary inferior vena cava clamping necessary. Most prominent surgical complications were hemorrhage, hematoma, and wound dehiscence. Renal failure occurred in 6.2% of patients. The overall median stay in the intensive and intermediate care unit was 14 days. The mortality rates within 30 and 90 days were 6.3% and 13.3%, respectively. No technique-related death occurred. The MPB technique by Belghiti is a feasible and simple LTx technique. The caval flow is preserved during the anhepatic phase, and this minimizes the need for venovenous bypass or portocaval shunt. This technique requires only 1 caval anastomosis, which is easy to perform with a short anhepatic phase. To minimize the risk of outflow obstruction, attention should be paid by doing a wide cavocavostomy cranially to the donor inferior vena cava in a door-lock manner. This technique can be applied in almost all patients undergoing LTx for the first time and liver retransplantation as well.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.21705","type":"journal-article","created":{"date-parts":[[2009,4,27]],"date-time":"2009-04-27T23:20:22Z","timestamp":1240874422000},"page":"466-474","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":62,"title":["A single-center experience of 500 liver transplants using the modified piggyback technique by Belghiti"],"prefix":"10.1097","volume":"15","author":[{"given":"Arianeb","family":"Mehrabi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhoobin A.","family":"Mood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamidreza","family":"Fonouni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arash","family":"Kashfi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Hillebrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha A.","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Encke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus W.","family":"B\u00fcchler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-4-20250330","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s00423-007-0262-6","article-title":"Current concepts in transplant surgery: liver transplantation today.","volume":"393","author":"Mehrabi","year":"2008","journal-title":"Langenbecks Arch Surg"},{"key":"R2-4-20250330","first-page":"659","article-title":"Homotransplantation of the liver in humans.","volume":"117","author":"Starzl","year":"1963","journal-title":"Surg Gynecol Obstet"},{"key":"R3-4-20250330","first-page":"3500","article-title":"Hemodynamic changes on clamping and unclamping of the major vessels during liver transplantation.","volume":"21","author":"Estrin","year":"1989","journal-title":"Transplant Proc"},{"key":"R4-4-20250330","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1136\/bmj.4.5630.535","article-title":"Liver transplantation in man. 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Observations on technique and organization in five cases.","volume":"4","author":"Calne","year":"1968","journal-title":"Br Med J"},{"key":"R5-4-20250330","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000658-198911000-00013","article-title":"Orthotopic liver transplantation with preservation of the vena cava.","volume":"210","author":"Tzakis","year":"1989","journal-title":"Ann Surg"},{"key":"R6-4-20250330","first-page":"682","article-title":"La technique du piggy back en transplantation hepatique.","volume":"119","author":"Meunier","year":"1993","journal-title":"Chirurgie"},{"key":"R7-4-20250330","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1001\/archsurg.1994.01420320068013","article-title":"Could the piggyback operation in liver transplantation be routinely used?","volume":"129","author":"Fleitas","year":"1994","journal-title":"Arch Surg"},{"key":"R8-4-20250330","first-page":"54","article-title":"Hemodynamic stability during the anhepatic phase of liver transplantation. 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