CAVOCAVAL LIVER-TRANSPLANTATION WITHOUT VENOVENOUS BYPASS AND WITHOUTTEMPORARY PORTACAVAL SHUNTING - THE IDEAL TECHNIQUE FOR ADULT LIVER GRAFTING

The influence of the implantation technique on the outcome was studied prospectively in a series of 116 consecutive adult patients undergoin g primary liver transplantation during the period January 1991-June 19 94. Thirty-eight patients (32.8 %; group 1) underwent classical orthot opic liver transplantation (OLT) with replacement of the recipient's i nferior vena cava (R-IVC) and with veno-venous bypass (VVB). Thirty-ni ne patients (33.6 %) had a piggy-back OLT with preservation of the R-I VC (group 2); bypass was used in 17 of them (43.6 %) because of poor h emodynamic tolerance of R-IVC occlusion. Thirty-nine patients (33.6 %) had OLT without VVB and with side-to-side cavocaval anastomosis (grou p 3). The three techniques were performed irrespective of the anatomic al situation and of the status of the recipient at the time of transpl antation. The following parameters were assessed in all patients: impl antation time, blood product use, morbidity (e. g., hemorrhagic, thora cic, gastrointestinal, neurological, and renal complications), and out come. Thirty-one patients underwent detailed intraoperative hemodynami c assessment. The early (< 3 months) post-transplant mortality of 10.3 % (12/116 patients) was unrelated to the implantation technique, Grou p 3 had a significantly shorter mean implantation time, a reduced need for intraoperative blood products, and a lower rate of reoperation du e to intra-abdominal bleeding. After excluding two immediate periopera tive deaths and eight patients requiring early retransplantation becau se of primary nonfunction, the frequency of immediate extubation was s ignificantly higher in group 3. Detailed hemodynamic assessment did no t show a difference between 6 group 1 patients and 17 group 3 patients , indicating that partial lateral clamping of the IVC fullfills the fu nction of venous bypass. Similar results were obtained in 6 group 2 pa tients who did not have IVC occlusion. Cavocaval OLT has become our pr eferred method of liver implantation. It allows the transplantation to be performed without VVB, regardless of the anatomical situation and of the condition of the patient at the time of transplantation. Moreov er, it avoids all of the potential complications and costs of VVB.