Classic orthotopic liver transplantation without venovenous bypass: a report of 45 cases

Chen, Z.S; Zeng, Fanjun; Ming, Changsheng; Zou, Lin; Zhang, W.J; Wei, Lai; Jiang, Jianzhong; Zhu, X.H; Gong, Nianqiao; Liu, B; Liu, D.G; Chen, Z.K; Sui-sheng, Xia

doi:10.1016/s0041-1345(02)03927-1

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…Several studies have shown that cardiovascular dysfunction in the anhepatic TxF conventional procedure without venovenous bypass is quickly overcome by the use of vasopressors and fluids with discrete effects on cardiac and urinary output 30 . The onset of renal dysfunction in the postoperative period without conventional DVV, is increased in most studies 7 . However, it is a temporary disturbance and low morbidity, even compared with the piggyback technique 18 .…”

Section: The Conventional Liver Transplantation Without Venovenous Bymentioning

confidence: 99%

Transplante de fígado clínico sem desvio venovenoso

Fonseca-Neto¹

2011

ABCD, arq. bras. cir. dig.

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-Introduction -The use of a venovenous bypass in liver transplantation is a controversy source and discussion among anesthetists and transplant surgeons.Although it provides a stable hemodynamic state and metabolism during the anhepatic stage, venovenous bypass may lead to a number of complications, some of them with death. Aim -To review the current practice of using clinic venovenous bypass in liver transplantation, with its advantages and disadvantages. Method -A broad review of the literature was carried out, paying especial attention to articles published in the past ten years and indexed in PubMed and Medline. The following cross-referenced headings were used: liver transplantation, venovenous bypass, conventional technique, classic technique. The articles chosen for analysis were those of the greatest relevance and those considered "classics" in the subject. Conclusion -Liver transplantation without venovenous bypass is a safe and rapid technique. In most cases it can be used without giving rise to serious complications in patients with liver disease. ABCDDV/783RESUMO -Introdução -O problema da utilização do desvio venovenoso no transplante de fígado é um ponto de discussão e controvérsia entre anestesistas e cirurgiões transplantadores. Apesar de proporcionar ambiente hemometabólico estável durante a fase anepática o seu uso poderá levar a algumas complicações, inclusive fatais. Objetivo -Revisar a prática atual do uso do desvio venovenoso no transplante de fígado clínico, com suas vantagens e desvantagens. Método -Foi realizada ampla pesquisa na literatura, com especial atenção aos artigos publicados nos últimos 10 anos e indexados ao PubMed e Medline. Foram utilizados os seguintes descritores de forma cruzada: liver transplantation, venovenous bypass, conventional technique, classic technique. Entre os artigos encontrados foram considerados para análise os mais relevantes além dos considerados "clássicos" sobre o assunto. Conclusão -Transplante de fígado sem desvio venovenoso é técnica segura e rápida. Pode ser utilizada, com poucas exceções, sem acarretar complicações maiores nos pacientes com doença hepática.

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Section: The Conventional Liver Transplantation Without Venovenous Bymentioning

confidence: 99%

Transplante de fígado clínico sem desvio venovenoso

Fonseca-Neto¹

2011

ABCD, arq. bras. cir. dig.

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“…The clinical manifestation usually involve cirrhosis caused by different pathological factors, and the prognosis is poor for those with decompensated cirrhosis, which is defined by the presence of ascites, variceal bleeding, encephalopathy and/or jaundice ( 2 ). In China, liver failure of the majority of liver transplant recipients is due to hepatitis-induced liver cirrhosis, typically combined with portal hypertension; due to the presence of extensive collateral circulation, in the anhepatic phase, recirculation of blood is possible ( 3 ). Therefore, transplantation without veno-venous bypass is the primary type of surgery ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…In China, liver failure of the majority of liver transplant recipients is due to hepatitis-induced liver cirrhosis, typically combined with portal hypertension; due to the presence of extensive collateral circulation, in the anhepatic phase, recirculation of blood is possible ( 3 ). Therefore, transplantation without veno-venous bypass is the primary type of surgery ( 3 ). Currently, problems occur in the anhepatic and post-anhepatic phases, such as hemodynamic instability, metabolic disturbances, and ischemia-reperfusion injuries, which have attracted great attention ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Establishment of a reversible model of prehepatic portal hypertension in rats

Zhao

Dou

Gao

2016

Experimental and Therapeutic Medicine

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The aim of the present study was to improve upon the traditional model of pre-hepatic portal hypertension in rats, and simulate the anhepatic phase of orthotopic liver transplantation without veno-venous bypass. A reversible model of portal hypertension was induced by portal vein ligation, with a label ring ligated along the portal vein. A total of 135 male Wistar rats were divided into three groups: i) Normal control (NC) group; ii) portal hypertensive control (PHTC) group; and iii) reperfusion (R) group. In the R group, rats with portal hypertension underwent simultaneous clamping of the portal triad and retrohepatic vena cava for 1 h, followed by removal of the clamps to enable blood reperfusion. Portal venography and portal vein pressure were recorded during the surgery. Arterial oxygen pressure (PaO2), and alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) levels were determined, and pathological changes of the liver were investigated by immunohistochemical staining. The results demonstrated that, 3 weeks after portal vein ligation, the vein area and the free portal pressures in the PHTC group were significantly increased compared with those in the NC group. The serum ALT and AST levels in the R group at different time points were significantly elevated compared with those in the PHTC group, and reached their maximal levels at 24 h after reperfusion. Furthermore, the PaO2 at 24 h after reperfusion was significantly decreased. In conclusion, the reversible model of pre-hepatic portal hypertension in rats was successfully established using the introduction of a label ring. This model may be useful for basic research focusing on the anhepatic phase of orthotopic liver transplantation without veno-venous bypass.

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“…First, the placement of the DVV is capable of life-threatening complications, such as air embolism or venous thrombi and hypothermia 8 . Moreover, thanks to effective compensatory mechanisms, the benefits to reduced cardiac output do not appear to be as advantageous, given to the fact that this reduction, when it is not used, is not associated with increased morbidity and postoperative mortality 5 . Specifically, with respect to the development of acute kidney injury (AKI) after surgery, the data are still conflicting.…”

Section: Introductionmentioning

confidence: 99%

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

Fonseca-Neto¹,

Miranda²,

Melo³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Background -Acute kidney injury is one of the most common complications of orthotopic liver transplantation. The absence of universal criteria for definition of these conditions make comparisons difficult between studies. The conventional technique for transplantation is the total excision of the inferior vena cava during liver retro-native hepatectomy. Controversies about the effect of the conventional technique without venovenous bypass on renal function remain. Aim -To estimate the incidence and risk of acute kidney injury factors among recipients of orthotopic liver transplantation without conventional venovenous bypass. Methods -Was studied 375 patients undergoing orthotopic liver transplantation. Variables were analyzed in preoperative, intraoperative and postoperative complications in 153 patients undergoing orthotopic liver transplantation without conventional venovenous bypass. The criterion for acute kidney injury was serum creatinine ≥ 1.5 mg/dl or urinary debit <500 ml/24h within the first three days post-transplant. Univariate analysis and multivariate logistic regression were done. Results -All transplants were performed with grafts from deceased donors. Sixty patients (39.2%) had acute kidney injury. Age, body mass index, ChildTurcotte-Pugh, urea, hypertension, and preoperative serum creatinine were higher in the acute kidney injury group. During the intraoperative period, the group acute kidney injury had more reperfusion syndrome, transfusion of red blood cells, fresh frozen plasma and platelets. Postoperatively, the duration of mechanical ventilation and postoperative creatinine levels were also variable, with significant differences for the group of acute kidney injury. After logistic regression, the reperfusion syndrome, the class C of the Child-Turcotte-Pugh and postoperative serum creatinine showed differences. Conclusion -Acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass is a common disorder, but with good prognosis. Reperfusion syndrome, serum creatinine postoperatively and Child C are factors associated with acute kidney injury after orthotopic liver transplantation without conventional venovenous bypass. ABCDDV/781RESUMO -Racional -Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. Objetivo -Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. Métodos -Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fí...

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Classic orthotopic liver transplantation without venovenous bypass: a report of 45 cases

Cited by 4 publications

References 3 publications

Transplante de fígado clínico sem desvio venovenoso

Transplante de fígado clínico sem desvio venovenoso

Establishment of a reversible model of prehepatic portal hypertension in rats

Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso

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