Venous bypass in clinical liver transplantation

A venous bypass technique (BP) that does not require the use of systemic anticoagulation is used routinely at our institution in all adult patients during the anhepatic phase of liver transplantation (LT). Complete cardiopulmonary profiles were obtained in a subset of 28 consecutive cases. During th...

Full description

Saved in:
Bibliographic Details
Published in:Annals of surgery 1984-10, Vol.200 (4), p.524-534
Main Authors: Shaw, Jr, B W, Martin, D J, Marquez, J M, Kang, Y G, Bugbee, Jr, A C, Iwatsuki, S, Griffith, B P, Hardesty, R L, Bahnson, H T, Starzl, T E
Format: Article
Language:English
Subjects:
Adult
Axillary Vein
Blood Pressure
Blood Transfusion
Cardiac Output
Catheterization
Femoral Vein
Heparin - therapeutic use
Humans
Intraoperative Care
Kidney - physiology
Liver Transplantation
Oxygen Consumption
Portal Vein
Postoperative Period
Risk
Vascular Surgical Procedures - methods
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A venous bypass technique (BP) that does not require the use of systemic anticoagulation is used routinely at our institution in all adult patients during the anhepatic phase of liver transplantation (LT). Complete cardiopulmonary profiles were obtained in a subset of 28 consecutive cases. During the anhepatic phase while on bypass, mean arterial pressure, central venous pressure, and pulmonary arterial wedge pressure were maintained at prehepatectomy levels. Oxygen consumption fell secondary to a decrease in temperature and the removal of the liver. Consequently, cardiac index fell without an increase in arterial-venous O2 content difference, reflecting adequate tissue oxygenation. Compared with 63 patients in a previous series given LT without bypass (NBP), the 57 total BP patients experienced better postoperative renal function (p less than 0.001), required less blood use during surgery (p less than 0.01), and had better survival 30 days after LT. The equivalency of 90-day survival in these groups results from the lack of effect of BP on the long-term survival of patients considered at high risk for metabolic reasons. BP patients at high risk for technical considerations, however, survived LT whereas NBP patients did not. BP offers other advantages important in establishing LT as a service-oriented procedure.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198410000-00013