The need for venovenous bypass in liver transplantation.
Since introduction of the conventional liver transplantation (CLTx) by Starzl, which was based on the resection of recipient inferior vena cava (IVC) along the liver, the procedure has undergone several refinements. Successful use of venovenous bypass (VVB) was first introduced by Shaw et al., although in recent decades there has been controversy regarding the routine use of VVB during CLTx. With development of piggyback liver transplantation (PLTx), the use of caval clamping and VVB is avoided, leading to fewer complications related to VVB. However, some authors still advocate VVB in PLTx. The great diversity among centers in their use of VVB during CLTx, or even along the PLTx technique, has led to confusion regarding the indication setting for VVB. For this reason, we present an overview of the use of VVB in CLTx, the target of patients for whom VVB could be beneficial, and the needs assessment of VVB for patients undergoing PLTx. Recent studies have shown that with the advancement of surgical skills, refinement of surgical techniques, and improvements in anesthesiology, there are only limited indications for doing CLTx with VVB routinely. PLTx with preservation of IVC can be performed in almost all primary transplants and in the majority of re-transplantations without the need for VVB. Nevertheless, in a few selective cases with severe intra-operative hemodynamic instability, or with a failed test of transient IVC occlusion, the application of VVB is still justifiable. These indications should be judged intra-operatively and the decision is based on each center's preference.
Fonouni
Hamidreza
H
Department of General, Visceral and Transplant Surgery, University of Heidelberg, Germany.
Mehrabi
Arianeb
A
Soleimani
Mehrdad
M
Müller
Sascha A
SA
Büchler
Markus W
MW
Schmidt
Jan
J
Ann N Y Acad Sci. 1964 Nov 30;120:739-65
14235287
Liver Transpl. 2001 Oct;7(10):904-11
11679990
Hepatology. 1996 Jun;23(6):1418-28
8675159
Br J Surg. 2003 Jan;90(1):48-56
12520574
Perfusion. 2001 Jul;16(4):285-92
11486847
Langenbecks Arch Surg. 2008 May;393(3):245-60
18309513
Transplant Proc. 1999 Sep;31(6):2394-5
10500636
Transplant Proc. 1993 Apr;25(2):1865-6
8470204
Hepatogastroenterology. 2001 Mar-Apr;48(38):486-92
11379339
Transplantation. 2003 May 27;75(10):1740-5
12777866
Ann Surg. 1989 Nov;210(5):649-52
2818033
Transpl Int. 1997;10(2):109-12
9089994
Transplant Proc. 1987 Aug;19(4 Suppl 3):17-20
3303529
Ann Surg. 2000 Jun;231(6):814-23
10816624
J Cardiothorac Vasc Anesth. 2006 Oct;20(5):744-7
17023301
Am J Surg. 1995 Feb;169(2):277-9
7840394
Transplant Proc. 1989 Feb;21(1 Pt 2):2322-5
2652752
J Cardiothorac Vasc Anesth. 2006 Oct;20(5):742-3
17023300
Transplant Proc. 1969 Mar;1(1):216-22
4332530
Transplantation. 1994 Oct 15;58(7):793-6
7940712
Transpl Int. 1991 Sep;4(3):157-60
1958280
Transplantation. 1987 Jan;43(1):56-61
3541324
Br J Surg. 1995 Jul;82(7):986-9
7648127
Transpl Int. 1997;10(3):171-9
9163855
Transplant Proc. 2003 Aug;35(5):1913-4
12962846
Clin Transplant. 2000 Aug;14(4 Pt 2):370-4
10946773
Perfusion. 1991;6(3):203-8
10149509
Surgery. 1996 Sep;120(3):484-7
8784401
Am J Surg. 1995 Dec;170(6):671-5
7492024
J Am Coll Surg. 1995 Jun;180(6):729-32
7773489
Clin Transplant. 2004 Dec;18(6):686-93
15516245
Arch Surg. 1997 Feb;132(2):162-5
9041920
Transplant Proc. 1992 Feb;24(1):189-91
1539239
Transplantation. 1993 Dec;56(6):1541-5
8279034
Minerva Anestesiol. 1997 Jul-Aug;63(7-8):221-8
9489307
Liver Transpl. 2005 Jul;11(7):741-749
15973707
Liver Transpl Surg. 1997 Sep;3(5):518-25
9346795
Anesth Analg. 1992 Oct;75(4):489-94
1530159
Transplant Proc. 1987 Aug;19(4 Suppl 3):54-5
3303534
Surg Gynecol Obstet. 1992 Sep;175(3):270-2
1514163
J Cardiothorac Vasc Anesth. 2001 Aug;15(4):460-2
11505350
Anesth Analg. 1993 Sep;77(3):642
8368571
Clin Transplant. 1996 Apr;10(2):181-5
8664515
Transplant Proc. 1989 Jun;21(3):3500-5
2662498
Liver Transpl. 2001 Nov;7(11):983-7
11699035
Transplant Proc. 1987 Feb;19(1 Pt 3):2416
3274528
Lancet. 1979 Sep 22;2(8143):612-4
90273
Transplant Proc. 1993 Apr;25(2):1841
8470193
Liver Transpl. 2000 Mar;6(2):157-62
10719013
Semin Liver Dis. 1985 Nov;5(4):344-8
3909428
Anesth Analg. 1989 Apr;68(4):489-96
2648895
Liver Transpl. 2000 Jul;6(4):471-9
10915171
Acta radiol. 1953 May;39(5):368-76
13057644
Rays. 1994 Jul-Sep;19(3):319-38
7800841
Surg Gynecol Obstet. 1960 Dec;111:733-43
18979655
Liver Transpl. 2004 Mar;10(3):425-33
15004772
Liver Transpl Surg. 1998 Mar;4(2):133-40
9516565
Ann Surg. 1960 Sep;152:374-87
13772284
Langenbecks Arch Surg. 2000 Aug;385(5):350-6
11026707
Transplant Proc. 1989 Oct;21(5):3859-60
2815296
J Am Coll Surg. 1998 Jun;186(6):683-90
9632158
Transpl Int. 2006 Oct;19(10):795-801
16961770
Transpl Int. 1993;6(5):299-301
8216710
Transplant Proc. 1990 Aug;22(4):1533-4
2389392
J Cardiovasc Surg (Torino). 1989 Jan-Feb;30(1):118-23
2925769
Br Med J. 1968 Nov 30;4(5630):535-40
4881063
Transplantation. 1999 Sep 15;68(5):646-50
10507483
Surg Gynecol Obstet. 1985 Mar;160(3):270-2
3883552
Transplant Proc. 1995 Feb;27(1):1254-5
7878872
Transplant Bull. 1959 Jan;6(1):103-7
13635834
Anaesthesia. 1995 Sep;50(9):776-8
7573866
Transplant Proc. 1989 Jun;21(3):3497-9
2662497
Transplantation. 1998 Jan 15;65(1):77-82
9448148
Transplant Proc. 1993 Aug;25(4):2588-9
8356680
Transplant Proc. 1987 Aug;19(4 Suppl 3):13-6
3303528
Transplantation. 2003 Dec 27;76(12):1724-8
14688523
Surg Gynecol Obstet. 1993 Feb;176(2):180-2
8421808
J Cardiothorac Vasc Anesth. 1994 Feb;8(1):58-60
8167287
J Am Coll Surg. 1994 Nov;179(5):573-6
7952461
Ann Surg. 1984 Oct;200(4):524-34
6385876
Transpl Int. 1994;7 Suppl 1:S152-4
11271191
Transplant Proc. 1999 Nov;31(7):3064-6
10578397
Transplant Proc. 2006 Jan-Feb;38(1):215-8
16504706
Anesth Analg. 2003 Jul;97(1):21-8, table of contents
12818937