VENA CAVE VASCULAR RECONSTRUCTION DURING ORTHOTOPIC LIVER-TRANSPLANTATION - A COMPARATIVE-STUDY

The aim of this study was to evaluate the influence of preserving the recipient's inferior vena cava during orthotopic liver transplantation (OLT) on hemodynamic alterations, blood component requirements, posto perative liver and renal function, as well as vascular-related complic ations. A total of 122 OLTs was studied. In 35 OLTs, venovenous bypass (BP) was used; in 35 OLTs, bypass was not used (NBP); and in 52 OLTs, the recipient's inferior vena cava was preserved (PC). Preservation o f the inferior vena cava means that Venous return is not compromised a t any time during transplantation. The time of hepatectomy was not dif ferent among the three groups (208 +/- 11, 188 +/- 13, and 194 +/- 6 m inutes for BP, NBP, and PC, respectively); however, the total operatin g time was significantly lower in PC patients (492 +/- 24, 459 +/- 18, and 419 +/- 10 minutes for BP, NBP, and PC, respectively; P = .004, A NOVA). Blood component requirements were significantly lower in patien ts with PC. For red blood cells, these were 15.2 +/- 2.6, 16 +/- 3.4, and 7.1 +/- 1.5 units for BP, NBP, and PC, respectively (P = .009, ANO VA), and for fresh-frozen plasma, these were 5.4 +/- .7, 5.8 +/- .9, a nd 3 +/- .4 L for BP, NBP, and PC, respectively (P = .005, ANOVA). Pos toperative liver and renal function did not differ among the three gro ups. The incidence of surgical complications (bleeding and vascular) w as similar. Preservation of the inferior vena cava of the recipient si gnificantly reduces the magnitude of OLT. Copyright (C) 1998 by the Am erican Association for the Study of Liver Diseases.