ORTHOTOPIC LIVER-TRANSPLANTATION WITH SELECTIVE USE OF VENOVENOUS BYPASS

BACKGROUND: To determine the utility of selective use of venovenous by pass (VVB), an algorithm based upon hemodynamic criteria was institute d at Stanford University Medical Center: the bypass was used if the sy stolic blood pressure decreased below 100 mm Hg with a trial of caval and portal clamping. PATIENTS AND METHODS: Eleven consecutive patients underwent orthotopic liver transplantation (OLT) with use of VVB on a selective basis; using the hemodynamic exclusion criteria, none requi red VVB. A group of 20 patients undergoing OLT with VVB served as hist orical controls. RESULTS: Overall patient and graft survival were iden tical in both groups (75%). Avoidance of WE decreased operative and wa rm ischemia time and decreased peak transaminase and total bilirubin v alues, but increased rates of intraoperative blood loss. However, the absolute numbers of blood products administered were not different bet ween groups. CONCLUSION: Selective use of VVB for OLT does not incur i ncreased morbidity or mortality. Potential advantages include cost sav ings with decreased operative and anesthetic time.