Intensive care during prolonged anhepatic state after total hepatectomy and porto-caval shunt (two-stage procedure) in surgical complications of liver transplantation.
OBJECTIVE
Recently, total hepatectomy and temporary porto-caval shunt has been indicated in surgical complications of liver transplantation. Four cases of liver transplantation which presented liver hemorrhage at the time of implant, and a 5th case with surgical trauma of hepatic hilum are presented.


METHODS
The graft was removed and a porto-caval shunt was performed in all patients. Retransplantation was possible in all recipients, after an anhepatic period of 16-24 hours.


RESULTS
Early persistent ionic hypocalcemia and late olyguric renal failure were the most constant and prominent complications during the anhepatic period. Two patients died of renal failure and respiratory distress syndrome at 6 and 28 days, respectively, after liver transplantation. The other 3 patients are alive and without complications at 48, 33 and 11 months of follow-up.


CONCLUSIONS
Total hepatectomy with a temporary porto-caval shunt and later retransplantation must be considered as a useful procedure for surgical complications of liver transplantation which may not be treated using other techniques. Special attention should be paid to preserve renal function in the anhepatic state in order to improve survival in similar cases of two-stage liver transplantation.
Bustamante
M
M
Liver Transplantation Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
Castroagudín
J F
JF
Gonzalez-Quintela
A
A
Martinez
J
J
Segade
F R
FR
Fernandez
A
A
Galban
C
C
Varo
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006996:Hypocalcemia / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome