[Liver transplantation preserving the vena cava and a temporary portocaval shunt].
The experience with laterolateral cavocavostomy for hepatovenous reconstruction in liver transplantation is reviewed with and without the use of a temporary portocaval shunt. A total of 65 liver transplantations were analyzed. In 49 transplantations a laterolateral cavocaval anastomosis was performed (group I). In group II (n = 16) the same technique was used after a temporary portal caval shunt was constructed. Mean arterial pressure (mmHg): group I 128 +/- 34; group II 109 +/- 32. Cardiac output (l/min) decrease during the anhepatic phase was 2.3 +/- 1.9 and 1.2 +/- 1.5, respectively (P < 0.05). The peroperative blood loss measured as the number of packed cells transfused was 16.4 +/- 15.8 versus 1.2 +/- 2.3 (P < 0.04) and fresh frozen plasma 19.0 +/- 14.7 versus 3.7 +/- 4.0 (P < 0.02). Course on ICU (days), liver function tests, renal function and the need for reoperation because of bleeding were not statistically significantly different between the groups. One-year patient survival was 82.7 and 85.7%, respectively. In conclusion, we found that despite preservation of the caval flow during hepatectomy, the additional use of a temporary portocaval shunt was advantageous with regard to peroperative hemorrhage and hemodynamic stability and can potentially facilitate implantation of the liver graft.
Hesse
U J
UJ
Chirurgische Klinik, Universitätsklinik Gent, Belgien.
Berrevoet
F
F
Troisi
R
R
Mortier
E
E
Decruyenaere
J
J
Pattyn
P
P
de Hemptinne
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*