Pulmonary evolution in conventional liver transplantation with venovenous bypass and the piggyback method

Carvalho, Eliane Maria de; Massarollo, Paulo Celso Bosco; Isern, Maria Rita Montenegro; Toledo, Nair S. G.; Kawacama, J; Mies, Sérgio; Raia, Silvano

doi:10.1016/s0041-1345(99)00674-0

Cited by 15 publications

(18 citation statements)

References 16 publications

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“…It has been suggested that splanchnic congestion during liver transplantation leads to deleterious effects on hepatic and pulmonary integrity (3)(4)(5)(6). We evaluated whether a portosystemic shunt could avoid these undesirable effects.…”

Section: Discussionmentioning

confidence: 99%

“…During hepatic reperfusion in the recipient, it seems that the release into the systemic circulation of proinflammatory substances from the intestine and spleen, resulting from splanchnic congestion, induces liver and lung damage (3)(4)(5)(6). Conversely, other authors have suggested that the graft by itself is the main source of proinflammatory mediators potentially responsible for the deleterious effects on the hepatocytes and the damaging effects on pulmonary integrity observed after hepatic I/R (7,8).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Role of ischemic preconditioning and the portosystemic shunt in the prevention of liver and lung damage after rat liver transplantation1

Fernández¹,

Heredia²,

Peralta

et al. 2003

Transplantation

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Role of ischemic preconditioning and the portosystemic shunt in the prevention of liver and lung damage after rat liver transplantation1

Fernández¹,

Heredia²,

Peralta

et al. 2003

Transplantation

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“…Furthermore, the PLTx technique has been attributed with better tissue perfusion attenuating the risk of cerebral perfusion problems. Regarding the rate of pulmonary complications, a study by Isern et al showed no significant differences between CLTx with VVB and PLTx without VVB, but other studies noted that extensive fluid administration in PLTx with the absence of VVB on one side and bacterial translocation because of portal clamping on the other led to a higher trend of complications, including pneumonia, pulmonary edema and infiltrates, atelectasis, and pleural effusion, which could subside by precise volume optimization as well as performing temporary porto‐systemic shunts 74–77 . Nevertheless, there were no significant differences regarding pulmonary gas exchange, pulmonary compliance, duration of mechanical ventilation, length of hospital stay, or patient mortality 74 .…”

Section: Venovenous Bypass In Pltxmentioning

confidence: 98%

The need for venovenous bypass in liver transplantation

Fonouni

Mehrabi

Soleimani

et al. 2008

HPB

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Since introduction of the conventional liver transplantation (CLTx) by Starzl, which was based on the resection of recipient inferior vena cava (IVC) along the liver, the procedure has undergone several refinements. Successful use of venovenous bypass (VVB) was first introduced by Shaw et al., although in recent decades there has been controversy regarding the routine use of VVB during CLTx. With development of piggyback liver transplantation (PLTx), the use of caval clamping and VVB is avoided, leading to fewer complications related to VVB. However, some authors still advocate VVB in PLTx. The great diversity among centers in their use of VVB during CLTx, or even along the PLTx technique, has led to confusion regarding the indication setting for VVB. For this reason, we present an overview of the use of VVB in CLTx, the target of patients for whom VVB could be beneficial, and the needs assessment of VVB for patients undergoing PLTx. Recent studies have shown that with the advancement of surgical skills, refinement of surgical techniques, and improvements in anesthesiology, there are only limited indications for doing CLTx with VVB routinely. PLTx with preservation of IVC can be performed in almost all primary transplants and in the majority of re-transplantations without the need for VVB. Nevertheless, in a few selective cases with severe intra-operative hemodynamic instability, or with a failed test of transient IVC occlusion, the application of VVB is still justifiable. These indications should be judged intra-operatively and the decision is based on each center's preference.

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“…In liver transplants, the frequency of right diaphragm paralysis can reach up to 44%. [9][10][11][12][13][14] The diaphragmatic dysfunction may lead to postoperative respiratory complications. The tidal volume and the vital capacity decrease because of the reduced movement of the diaphragm.…”

mentioning

confidence: 99%

Left Hemidiaphragmatic Mobility

Toledo

Kodaira

Massarollo

et al. 2006

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. Methods. Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. Results. The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 × splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 × inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 ± 16.1 mm; P < .05 [hilum]; 18.9 ± 14.2 mm; P < .05 [inferior pole]). Conclusions. These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.

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Pulmonary evolution in conventional liver transplantation with venovenous bypass and the piggyback method

Cited by 15 publications

References 16 publications

Role of ischemic preconditioning and the portosystemic shunt in the prevention of liver and lung damage after rat liver transplantation1

Role of ischemic preconditioning and the portosystemic shunt in the prevention of liver and lung damage after rat liver transplantation1

The need for venovenous bypass in liver transplantation

Left Hemidiaphragmatic Mobility

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