Cavocaval adult liver transplantation and retransplantation without venovenous bypass and without portocaval shunting: a prospective feasibility study in adult liver transplantation.
BACKGROUND
The original method of liver transplantation (LT) included recipient inferior vena cava (IVC) resection and the use of extracorporeal venovenous bypass (VVB). Refinements in technique permit transplantation to be done with IVC preservation and without VVB use.


METHODS
Between November 1993 and November 2000, 202 consecutive grafts were performed in 188 adults (>/=16 years of age). Twelve patients (6.4%) received two and three retransplants (re-LT). Split grafting was performed 19 times (19 of 202 grafts, 9.4%). Risk factors included United Network of Organ Sharing status I (n=30, 16%), previous right upper abdominal surgery (n=32, 17.1%), caudate lobe encirclement of IVC (n=65, 32.2%), IVC (n=24, 11.9%), and splanchnic venous modification (n=58, 30.9%), transjugular intrahepatic portosystemic stent shunt (n=34, 16.8%), giant (>5 kg) liver tumor (n=6, 3%), septic necrosis of the caudate lobe (n=1, 0.5%), and previous cavocaval (n=13, 6.4%) or classical LT (n=5, 2.5%).


RESULTS
IVC preservation, avoidance of IVC cross clamping and of VVB use were possible in 98.9%, 93%, and 99.5% of 183 primary LT and in 89.5%, 84.2%, and 89.5% of 19 re-LT. Temporary portocaval shunting was never applied. Perioperative mortality was 1.2%. There was no allotransfusion in 73 (36%) grafts and 45 (22%) patients were immediately extubated. Permanent hepatic vein and caval problems were encountered in three (1.5%) grafts. One patient needed stent placement to treat IVC stenosis. Actual 3- and 12-month patient survival for whole, re-LT, and right-lobe split LT groups were 94.7%, 94.1%, 94.7%, 88.2%, 94.1%, and 89%. Three-month graft survival rates for these groups were 92.6%, 94.7%, and 84.2%.


CONCLUSIONS
LT with IVC preservation and without VVB use and portocaval shunting is possible in nearly all primary transplants and in the majority of re-LT.
Lerut
Jan
J
Department of Digestive Surgery, Liver Transplant Program, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. Lerut@chir.ucl.ac.be.
Ciccarelli
Olga
O
Roggen
Francine
F
Laterre
Pierre-François
PF
Danse
Etienne
E
Goffette
Pierre
P
Aunac
Sophie
S
Carlier
Marianne
M
De Kock
Marc
M
Van Obbergh
Luc
L
Veyckemans
Francis
F
Guerrieri
Claudine
C
Reding
Raymond
R
Otte
Jean-Bernard
JB
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011446:Prospective Studies; D012086:Reoperation; D016019:Survival Analysis; D014680:Veins / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery*