title: Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass-Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program.
abstract: Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Mossdorf
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ulmer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Junge
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heidenhain
authors.affiliation: Department of Anaesthesiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Hein
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Temizel
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Ulf Peter
authors.initials: UP
authors.lastname: Neumann
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Schöning
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmeding
references.citation: Langenbecks Arch Surg. 2000 Aug;385(5):350-6
references.pmid: 11026707
references.citation: Transplantation. 1994 Oct 15;58(7):793-6
references.pmid: 7940712
references.citation: Transpl Int. 2006 Oct;19(10):795-801
references.pmid: 16961770
references.citation: Liver Transpl. 2008 Apr;14(4):504-8
references.pmid: 18383079
references.citation: Transpl Int. 2005 Mar;18(3):318-25
references.pmid: 15730493
references.citation: Transpl Int. 1997;10(2):109-12
references.pmid: 9089994
references.citation: Exp Clin Transplant. 2009 Mar;7(1):25-7
references.pmid: 19364308
references.citation: Chirurg. 2012 Nov;83(11):980-8
references.pmid: 22810545
references.citation: J Am Coll Surg. 1998 Jun;186(6):683-90
references.pmid: 9632158
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007712
references.pmid: 21412907
references.citation: Transpl Int. 2010 Dec;23(12):1247-58
references.pmid: 20723178
references.citation: HPB (Oxford). 2006;8(3):182-8
references.pmid: 18333273
references.citation: Liver Transpl. 2009 May;15(5):466-74
references.pmid: 19399735
references.citation: Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):242-9
references.pmid: 24919606
references.citation: Transplant Proc. 2003 Aug;35(5):1913-4
references.pmid: 12962846
references.citation: J Am Coll Surg. 2012 Apr;214(4):691-8; discussion 698-9
references.pmid: 22364695
references.citation: Clin Transplant. 2004 Dec;18(6):686-93
references.pmid: 15516245