Orthotopic liver transplantation with selective use of venovenous bypass

Kuo, Paul C.; Alfrey, Edward J.; García, Gabriel; Haddow, Gordon R.; Dafoe, Donald C.

doi:10.1016/s0002-9610(99)80039-7

Cited by 31 publications

(23 citation statements)

References 7 publications

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“…In recent years, several centres have demonstrated that venovenous bypass was not necessary in all patients even when the cardiac output after caval clamping decreased by more than 50 per cent 25 , and have advocated selective use of venovenous bypass 26,27 . The present study showed that venovenous bypass could be avoided completely, even in a situation where the graft size was smaller than normal and a higher degree of reperfusion graft injury was anticipated 28 .…”

Section: Discussionmentioning

confidence: 99%

Right lobe living donor liver transplantation with or without venovenous bypass

Fan

Yong

et al. 2003

British Journal of Surgery

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Background: Venovenous bypass was considered necessary to maintain haemodynamic stability and avoid splanchnic and retroperitoneal congestion during the anhepatic phase of liver transplantation. It was essential for right lobe living donor liver transplantation (LDLT) in which the inferior vena cava needed to be cross-clamped to construct wide and short hepatic vein anastomoses. However, many complications related to venovenous bypass have been reported. This study aimed to determine whether venovenous bypass was necessary for right lobe LDLT. Results: Compared with patients undergoing operation without venovenous bypass, patients who had venovenous bypass required significantly more blood, fresh frozen plasma and platelet infusion, and had a lower body temperature; their postoperative hepatic and renal function in the first week was worse than that in patients who did not have a bypass. The time to tracheal extubation was longer and the incidence of reintubation for ventilatory support was higher with venovenous bypass. Six of the 29 patients with venovenous bypass died in hospital, compared with two of the 43 patients without a bypass (P = 0·05). By multivariate analysis, the lowest body temperature during the transplant operation was the most significant factor that determined hospital death. Conclusion:Venovenous bypass is not necessary and is probably harmful to patients undergoing right lobe LDLT, and should therefore be avoided.

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Section: Discussionmentioning

confidence: 99%

Right lobe living donor liver transplantation with or without venovenous bypass

Fan

Yong

et al. 2003

British Journal of Surgery

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“…• Low [24] and high [23] age of the recipient • Certain diseases (biliary atresia [23], postnecrotic cirrhosis [26], hepatitis [26], sclerosing cholangitis [26]) • Ascites [25] • Encephalopathy in infants [24] • Poor general health status of the patient [26] • Poor nutritional status in infants [24] • Former upper abdominal surgery [2] • Insufficient production of coagulation factors [24,[28][29][30] • Low platelet count [28,29,31] • Probably preoperative prothrombin time [22,24,25] and partial thromboboplastin time [22,28,29] • Probably long cold-ischemia time of the graft [28,29] • Probably no use of venovenous bypass [27] over, sometimes questionable statements were made concerning parameters such as preoperative coagulation tests [22]. Patients older than 50 years [23] or younger than 1.8 years [24] seems to require increased amounts of intraoperative blood.…”

Section: Predictors Of Increased Intraoperative Blood Lossmentioning

confidence: 99%

“…Biliary atresia [23] in infants, ascites [25], postnecrotic cirrhosis [26], (acute) hepatitis [26], sclerosing cholangitis [26] and preexisting signs of far advanced disease such as encephalopathy [24] in infants are factors that have been associated with increased blood requirements during liver transplantation. In a small study, the use of a venovenous bypass during the anhepatic phase seemed to decrease blood loss [27]. Furthermore, good general health [26] and nutritional status in infants [24] appears to correlate inversely with the need of blood transfusion.…”

Section: Predictors Of Increased Intraoperative Blood Lossmentioning

confidence: 99%

“…However, autotransfusion has its limitations. The elimination of coagulation proteins and platelets before retransfusion makes it necessary to add het- [39,43,44] • Normothermia during transplantation [35] • Accepting lower hemoglobin levels perioperatively [5] • Use of autologous blood retransfusion [38][39][40][41][42] • Intraoperative use of estrogen [45,46] • Intraoperative use of antifibrinolytics (ε-aminocaproic acid [49,50], tranexamic acid [51], aprotinin [53][54][55][56][57][58][59][60][61][62][63][64]) • Intraoperative use of clonidin [67] • Intraoperative use of venovenous bypass during the anhepatic phase [27] • Perioperative use of thromboelastography [69,70] • Intraoperative use of argon beam coagulator • High standard of surgical experience erologous coagulation products [40], and the need for at least one technician operating the device increases cost. Furthermore, coagulase-negative staphylococci were detected in a few samples of processed blood [40], and recipients' malignant or infectious codiseases limited the use of this autotransfusion technique.…”

Section: Measures To Limit the Use Of Blood Productsmentioning

confidence: 99%

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Blood Product-Independent Liver Transplantation

Rieder¹,

Luginbühl²,

Seiler³

et al. 1999

Transfus Med Hemother

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Since the first human liver transplantation by Thomas E. Starzl in 1963 this operation has been considered among the most difficult ones. One of the factors influencing outcome of the graft, patient survival, and cost of the procedure is the amount of blood products being used during liver transplantation. Between 1981 and 1985 the average use of blood products per patient during liver transplantation at the University Hospital of Pittsburgh, PA, was 25 units of red blood cells (RBCs), 24 units of fresh frozen plasma (FFP), 9 units of cryoprecipitates and 20 units of platelets. In some difficult cases several hundred units of blood products were required to treat one single patient. Thus keeping up with the requirements of liver transplantation can be a very demanding task for any blood bank. Although massive blood transfusion may still occasionally be required, the use of blood products during liver transplantation has declined in recent years due to several factors. We recently presented our own experience of blood requirements during liver transplantation. At the University Hospital of Bern median blood replacement has decreased from 9 RBCs per patient between 1991 and 1993 to a median of 3 RBCs per patient in the period from 1995 to 1998. Three patients out of 75 (4%) who had liver transplantation at our institution between 1991 and 1998 did not receive any perioperative blood products. Furthermore, 13 (17%) received no RBCs, 5 (7%) had no FFP, and 23 (30%) received no platelet-rich plasma. This review discusses the pathophysiology of patients with terminal chronic liver insufficiency with regard to their hematologic and cardiovascular condition during the intraoperative phases of orthotopic liver transplantation. The risk of giving blood products to these patients, the possible predictors of increased intraoperative blood loss, and some of the available options to limit the use of blood products are addressed.

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“…The technique has been improved and refined several times since it was first applied during the earliest attempts at human OLT in 1963 [37]. It is now recognized as an integral part of a standard OLT [21], although some have questioned its routine use [3,14,18,39,401. Application of VVBP preserves renal function [32, 391, decreases peroperative blood loss [32], and reduces third space fluid losses, visceral edema, and splanchnic venous pooling [21,32].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

Scholz¹,

Aasen²,

Mathisen³

et al. 1997

Transplant Int

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We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique. Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction of a heat exchanger offer significant benefits and that they are safe and reliable.

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Orthotopic liver transplantation with selective use of venovenous bypass

Cited by 31 publications

References 7 publications

Right lobe living donor liver transplantation with or without venovenous bypass

Right lobe living donor liver transplantation with or without venovenous bypass

Blood Product-Independent Liver Transplantation

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

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