SELECTIVE USE OF VENOVENOUS BYPASS IN ORTHOTOPIC LIVER-TRANSPLANTATION

The use of veno-venous bypass (VVB) during the anhepatic phase of orth otopic liver transplantation (OLT) remains controversial. We employ VV B on a selective basis: patients who tolerate intra-operative supra-he patic IVC test cross-clamping undergo OLT without VVB while patients w ho, despite maximal volume resuscitation, develop hemodynamic instabil ity during test cross-clamping, undergo OLT with VVB. The records of 1 50 adult orthotopic liver allograft recipients transplanted at the Mas sachusetts General Hospital from January 1984 to December 1994 were re viewed to identify any potential adverse affects on peri-operative, 6 months, 1 year outcomes in recipients foregoing VVB during liver trans plantation. Thirty-eight patients (25%) underwent OLT without VVB with actuarial survivals of 78.4% and 69% at 6 months and 1 year. 112 pati ents (75%) underwent OLT with VVB with actuarial survivals at 6 months and 1 year of 73% and 72%. Demographic data, UNOS status, and diagnos es were similar in each group. There were no significant differences i n intra-operative PRBC requirements; lengths of hospital stay; retrans plantation rates; or 30 day, 6 months and 1 year survivals between the se two groups. There was no significant difference in renal function a s determined by preoperative, peak post-operative, discharge serum cre atinine levels, or number of patients requiring HD between these two g roups. There were two major complications (1.8%) possibly resulting fr om VVB. In conclusion, patients who tolerate IVC test cross-clamping c an safely undergo orthotopic liver transplantation without veno-venous bypass. In our experience, there were no significant differences in p erioperative parameters, post-operative renal function, or short-term survival when compared to patients who, due to hemodynamic instability during IVC cross-clamping, underwent OLT with VVB. Given the potentia l complications associated with WE, we feel that in those patients who tolerate intra-operative IVC cross-clamping, it is better to proceed without the use of VVB.