Evaluation of surgical and anesthetic strategy as a key factor in the postoperative results of liver transplant.
Since the inauguration of our liver transplant program two years ago, retrospectively we can distinguish two different periods as regards postoperative results. The patients studied were distributed in two groups by chronological order and date of introduction of an improved surgical and anesthetic strategy: retrohepatic dissection during the veno-venous bypass phase and meticulous hemostasis in the anhepatic phase: Group A: 11 transplants in 10 patients and Group B: 22 transplants in 21 patients. Preoperatively, both groups were homogeneous with respect to the clinical situation. During the operation, significantly larger transfusion volumes were given in group A (25.4 +/- 10.5 ml/kg/hr) than in group B (10.0 +/- 5.7 ml/kg/hr) (p less than 0.01). The anhepatic phase lasted 1'50" +/- 20" in group B (p less than 0.05). The postoperative outcome of group B was better than that of A as regards hemodynamic and respiratory parameters, functional impairment of the graft and mortality (p less than 0.05). We conclude that the realization of retrohepatic dissection and careful hemostasis during the anhepatic phase, which prolongs the duration of venovenous by-pass but does not increase intraoperative morbidity, reduces the need for blood transfusion, and yields better postoperative results.
Moreno González
E
E
General and Digestive Surgery Department C, Hospital Primero de Octubre, Madrid, Spain.
Pérez-Cerdá
F
F
Calleja Kempin
J
J
Landa Garcia
I
I
Gómez Gutiérrez
M
M
Jover Navalón
J M
JM
Riaño Carrera
D
D
Moral Gutiérrez
P
P
Guillén Ramirez
F
F
Arias Diaz
J
J
D000328:Adult; D000758:Anesthesia; D001803:Blood Transfusion; D002648:Child; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies