Venous bypass in clinical liver transplantation

B. W. Shaw, D. J. Martin, J. M. Marquez, Y. G. Kang, A. C. Bugbee, S. Iwatsuki, B. P. Griffith, R. L. Hardesty, H. T. Bahnson, T. E. Starzl

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Abstract

A venous bypass technique (BP) that does not require the use of systemic anticoagulation is used routinely at our institution in all adult patients during the anhepatic phase of liver transplantation (LT). Complete cardiopulmonary profiles were obtained in a subset of 28 consecutive cases. During the anhepatic phase while on bypass, mean arterial pressure, central venous pressure, and pulmonary arterial wedge pressure were maintained at prehepatectomy levels. Oxygen consumption fell secondary to a decrease in temperature and the removal of the liver. Consequently, cardiac index fell without an increase in arterial-venous O2 content difference, reflecting adequate tissue oxygenation. Compared with 63 patients in a previous series given LT without bypass (NBP), the 57 total BP patients experienced better postoperative renal function (p < 0.001), required less blood use during surgery (p < 0.01), and had better survival 30 days after LT. The equivalency of 90-day survival in these groups results from the lack of effect of BP on the long-term survival of patients considered at high risk for metabolic reasons. BP patients at high risk for technical considerations, however, survived LT whereas NBP patients did not. BP offers other advantages important in establishing LT as a service-oriented procedure.

Original languageEnglish (US)
Pages (from-to)524-534
Number of pages11
JournalAnnals of surgery
Volume200
Issue number4
StatePublished - Dec 19 1984

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ASJC Scopus subject areas

  • Surgery

Cite this

Shaw, B. W., Martin, D. J., Marquez, J. M., Kang, Y. G., Bugbee, A. C., Iwatsuki, S., Griffith, B. P., Hardesty, R. L., Bahnson, H. T., & Starzl, T. E. (1984). Venous bypass in clinical liver transplantation. Annals of surgery, 200(4), 524-534.