Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: Review of 1361 cases

Objective. The objective of this study was to describe the complications sp ecifically related to orthotopic liver transplantation (OLT) with preservat ion of the inferior vena cava and to their therapeutic management. This pre servation technique has considerably influenced the surgical phases of live r transplantation, increasing hepatectomy time and modifying the number of vascular anastomoses. Methods. Our retrospective multicentric study, based on data from 1361 adul t patients that had undergone orthotopic liver transplantation with preserv ation of the inferior vena cava in France between 1991 and 1997, analyzed t he concomitant surgical complications. Type of cavo-caval anastomosis perfo rmed (piggyback, end-to-side, or side-to-side), use of a temporary portacav al anastomosis, technique-related complications, and mortality, were invest igated. Results. Cavo-caval anastomosis was side-to-side in 50.6% of cases (n=689), piggyback, in 42.7% (n=582), and end-to-side in 6.6% (n=90). In total, 882 temporary portacaval anastomosis were carried out. Fifty-five patients pre sented with one or more complications related to the preservation of the in ferior vena cava technique; i.e., overall morbidity was 4.1% (55/1361), Ove rall mortality was 0.7% (10/1361), Mortality rate for patients who presente d with surgical complication was 18%. A total of 64 complications were reco rded: 57 (89%) were in the perioperative or immediate postoperative period and 7 (11%) were postoperative. Conclusions. These retrospective, descriptive results show significant adva ntages in favor of side-to-side anastomosis in terms of vascular complicati ons. Certain factors should be evaluated specifically at pretransplant asse ssment to prevent certain serious complications; principally, these are ana tomic factors of the recipient (inferior vena cava included in segment I, a natomic abnormalities of the inferior vena cava) and graft size. Depending on these factors, surgeons must be able to adapt the orthotopic liver trans plantation, either before or during orthotopic liver transplantation, prefe rring the standard technique.