Liver transplantation without venovenous bypass: Morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping

Objective: To investigate whether a decrease in cardiac output of greater t han or equal to 50% after vena cave clamping is associated with an increase in perioperative morbidity or mortality in patients undergoing orthotopic liver transplantation without venovenous bypass. Design: Retrospective, clinical study. Participants: Patients undergoing elective orthotopic liver transplantation without venovenous bypass (n = 172). Interventions: None. Measurements and Main Results: In 82 patients (group 1), the decrease in ca rdiac output after vena cava clamping was greater than or equal to 50%; in 90 patients (group 2), the decrease was < 50%. Hemodynamics during surgery and perioperative morbidity and mortality were compared between group 1 and group 2 patients. Mean arterial pressure during the anhepatic phase was no t significantly different between groups, but cardiac output and mixed veno us oxygen saturation were significantly lower in group 1 patients. Perioper ative mortality, need for postoperative renal replacement therapy, postoper ative serum creatinine levels, and graft function were not different betwee n groups. Conclusion: A > 50% reduction in cardiac output after vena cava clamping is not associated with an increase in perloperative morbidity and mortality w hen compared with patients with a less pronounced reduction in cardiac outp ut. These results question the common practice of basing the indication for venovenous bypass during the anhepatic phase on a reduction in cardiac out put of > 50% after a trial of vena cave clamping. Copyright (C) 2001 by W.B . Saunders Company.