Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass—Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program

Abstract

Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.

Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study

“…The abrupt influx of cold, hyperkalemic and acidic blood into the circulation, air or thrombotic embolization and the release of vasoactive substances from the graft liver contribute to PRS [ 29 – 31 ]. The rationale for using a venovenous/portalvenous bypass during the anhepatic phase at our center is to ensure maximum safety of the procedure [ 24 ]. The combination of a femoro-brachial and porto-axillary bypass reduces lower limb and mesenterial congestion and therefore reduces the abrupt influx of hyperkalemic and acidic blood into systemic circulation at the time of reperfusion.…”

“…Liver transplantation was performed using an extracorporeal venovenous/portal venous bypass. Anesthesiological management, bypass and surgical procedures, as well as the immune suppression regimen have already been described by Moosdorf and colleagues [ 24 ]. Anesthesiologists did not follow a specific coagulation or transfusion management protocol: Patient received at maximum 1 Liter of balanced electrolyte solution and volume replacement was subsequently conducted with FFP in order to anticipate the coagulation disorder.…”

Hypothermic oxygenated machine perfusion (HOPE) for orthotopic liver transplantation of human liver allografts from extended criteria donors (ECD) in donation after brain death (DBD): a prospective multicentre randomised controlled trial (HOPE ECD-DBD)

“…In centre 1, OLT will be performed using the total cava replacement technique with veno-venous bypass including the portomesenteric vascular bed using a roller pump system with an adjustable flow as previously described. 16 17 Biliary reconstruction will be performed as a side-to-side common bile duct anastomosis with T-tube insertion or primary Roux-en-Y hepaticojejunostomy in cases of primary sclerosing cholangitis as previously described. 18 External centres will use their local standard techniques for OLT.…”

“…The used immunosuppressive regimen is based on induction therapy with intravenous basiliximab and methylprednisolone followed by corresponding oral doses of prednisolone, tacrolimus and mycophenolate mofetil. 16 17 …”

Reversal of cardiomyopathy in propionic acidemia after liver transplantation: a 10-year follow-up

“…Considering the severely impaired cardiac function, an intra‐operative cardiac bypass was used preventively. In liver transplantation in patients with cardiac insufficiency, it is essential to evaluate the need for devices, as extracorporeal bypass to stabilize the haemodynamic conditions . The complete regression of both cardiomyopathy and long‐QT syndrome may suggest a similar underlying mechanism.…”