title: Orthotopic liver transplantation with vena cava preservation in cirrhotic patients: is systematic temporary portacaval anastomosis a justified procedure?
abstract: BACKGROUND
  We evaluated the peri- and postoperative effects of the lack of a temporary portocaval anastomosis (TPCA) during orthotopic liver transplantation (OLT) in 84 patients with cirrhosis.
  
  
  METHODS
  From December 1996 to December 2002, 156 liver transplant recipients included (54%; 60 men and 24 women) of mean age 52 +/- 9 years with portal hypertension. In whom peri- and postoperative data were analyzed.
  
  
  RESULTS
  The median fall in mean arterial pressure upon vascular clamping and unclampings was 20 mm Hg (range 15 to 75), while the median duration of portal vein clamping was 77 minutes. The median amount of blood autotransfusion was 1100 mL (range 0 to 5400). The median number of red blood cell and fresh-frozen plasma units transfused were 5 and 6.5, respectively. The median intraoperative urinary output was 72 mL/h (range 11 to 221). Three patients (3.5%) presented a perioperative complication, but no perioperative death was observed. Six patients experienced an early postoperative complication (<10 days): five hemodynamic complications and one transient renal failure, which did not require hemodialysis. One patient (1%) died at 12 hours after OLT from acute pulmonary edema.
  
  
  CONCLUSIONS
  This study shows that systematic TPCA during OLT with preservation of the native retrohepatic vena cava in cirrhotic patients does not appear to be justified. In contrast, peri- and postoperative hemodynamic parameters as well as blood component requirements were comparable to those of the literature reporting OLT with straightforward TPCA.
authors.affiliation: Hopitaux de Toulouse, Tolouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Muscari
authors.forename: B
authors.initials: B
authors.lastname: Suc
authors.forename: J
authors.initials: J
authors.lastname: Aguirre
authors.forename: G L
authors.initials: GL
authors.lastname: Di Mauro
authors.forename: E
authors.initials: E
authors.lastname: Bloom
authors.forename: J P
authors.initials: JP
authors.lastname: Duffas
authors.forename: P
authors.initials: P
authors.lastname: Blanc
authors.forename: G
authors.initials: G
authors.lastname: Fourtanier
mesh_terms: D005260:Female; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011167:Portacaval Shunt, Surgical; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery