Venovenous Bypass and Liver Transplantation

Circulatory pathophysiology and options in hemodynamic management during adult liver transplantation

“…3,23,36,37,47,48 VVBP was advocated to reduce the risk of perioperative renal failure 39,42 because the combination of hypoperfusion and venous hypertension during the anhepatic stage renders the kidneys particularly vulnerable to injury. [49][50][51] Renal perfusion pressure, an index of kidney perfusion and a guide to management during surgery, improved with the use of VVBP, 25,26,52 but higher Circulatory Changes During Liver Transplantation perfusion pressures did not affect the incidence of postoperative renal failure.…”

“…35 Although there are no reliable predictors of hemodynamic instability during venous occlusion, a marked hyperdynamic circulatory state, severe portal hypertension, and advanced age are associated with increased risk. [35][36][37] The underlying etiology of this association requires further exploration, but the evidence suggests that abnormalities in myocardial contractility, vascular response, and regulation of collateral blood flow are accentuated in these risk conditions.…”

“…Although ample evidence demonstrates better hemodynamic stability in patients treated with VVBP than in those treated with nonbypass crossclamp techniques, [42][43][44][45][46] data on intraoperative blood use, renal failure, and early mortality suggest that VVBP is not required in all transplant recipients. 3,23,36,37,47,48 VVBP was advocated to reduce the risk of perioperative renal failure 39,42 because the combination of hypoperfusion and venous hypertension during the anhepatic stage renders the kidneys particularly vulnerable to injury. [49][50][51] Renal perfusion pressure, an index of kidney perfusion and a guide to management during surgery, improved with the use of VVBP, 25,26,52 but higher…”

Bi̇r Vaka Nedeni̇ İle Karaci̇ğer Transplantasyonunda Anestezi̇k Yaklaşim

“…Transplantasyon merkezlerinin büyük çoğunluğunda bugün venövenöz bypass vena kavanın klemplendiği dönemde uygulanmaktadır (2,3,17). Ancak kullanım endikasyonları konusunda değişik gö-rüşler mevcuttur.…”

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

“…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].…”