VENOVENOUS BYPASS IN ADULT ORTHOTOPIC LIVER-TRANSPLANTATION - ROUTINEOR SELECTIVE USE

Background: The role of venovenous bypass (VVB) during orthotopic live r transplantation (OLT) remains controversial. The aims of this study were to evaluate the current role of VVB at all major centers in North America, to examine the results of OLT and complications of VVB betwe en two periods with a strict policy for routine versus selective use o f VVB, and to review the literature. Study Design: A survey of 50 majo r liver transplant centers was conducted using mailed questionnaires. A retrospective chart review was performed for 547 OLT patients having transplantation during two distinct periods with a strict policy for routine versus selective use of VVB at the University of Toronto, Cana da, and at Duke University Medical Center, Durham, North Carolina. The literature was reviewed with a focus on the benefits and indications for routine versus selective use of VVB. Results: Thirty-eight (76%) o f 50 centers responded. Sixteen (42%) of them used VVB routinely, with a reported complication rate of 10-30%. Lymphocele and hematoma were the most common complications, but patients having major vascular inju ry, air embolism, and death were reported. A recent change to selectiv e use of VVB was reported in 30% of the centers (11 of 38). In the Duk e-Toronto series, the complication rates were similar between the two periods, at 13.4% and 18.8%, respectively. The outcome of OLT was not influenced by the policy of routine or selective use of VVB. Conclusio ns: There is a trend away from the routine use of VVB during OLT. Intr aoperative hemodynamic instability during the hepatectomy and a failed trial of hepatic venous occlusion were the most important criteria fo r using VVB. We conclude that VVB should be used selectively to avoid associated complications and to decrease operative time and costs. (C) 1998 by the American College of Surgeons.