Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation

Hypothermia during orthotopic liver transplantation (OLT) is common despite measures to prevent this complication. We retrospectively analyzed two gro ups of patients; those managed with (n = 113) or without (n = 109) a heat e xchanger (HE) incorporated in the venovenous bypass (VVB) circuit to test t he hypothesis that normothermia before liver reperfusion minimizes hypotens ion during reperfusion and decreases neohepatic transfusion requirements. U se of the HE resulted in significantly warmer patients during reperfusion a nd at the end of surgery (P < .001). An increase in neohepatic transfusion requirement was observed in patients with HE use: packed red blood cells, 4 +/- 4 Versus 3 +/- 3 units; fresh-frozen plasma, 5 +/- 5 versus 4 +/- 4 un its; platelets, 8 +/- 8 versus 6 +/- 7 units; and cryoprecipitate, 5 +/- 7 versus 3 +/- 5 units. There was no difference between the two groups in the untoward hemodynamic events during reperfusion of the liver (P = .31). We conclude that during OLT, the use of an HE in a nonheparinized VVB circuit helps maintain normothermia. Our limited experience suggests that its use i s safe but does not improve hemodynamic stability during reperfusion or dec rease blood loss during the neohepatic period. (C) 1998 by the American Ass ociation for the Study of Liver Diseases.