Portacaval Shunt and Inferior Vena Cava Preservation in Orthotopic Liver Transplantation

• Published in: Transplantation proceedings Vol. 37; no. 9; pp. 3896 - 3898
• Main Authors: Margarit, C., Lopez de Cenarruzabeitia, I., Lázaro, J.L., Cancino, J.D., Rojas, L.H., Escartı́n, A., Mora, A., Bilbao, I.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2005; Elsevier Science
• Subjects: Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Liver Cirrhosis - surgery; Liver Transplantation - methods; Male; Medical sciences; Organ Preservation - methods; Portacaval Shunt, Surgical - methods; Portal Vein - physiopathology; Retrospective Studies; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Vena Cava, Inferior - surgery; Medicine; Orthotopic transplantation; Organ preservation; Treatment; Preservation; Shunt; Digestive system; Surgery; Liver; Graft; Homotransplantation; Inferior vena cava
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.10.062

The aim was to study the advantages of the use of a temporary portacaval shunt (PCS) with inferior vena cava (IVC) preservation during the piggyback technique for the anhepatic phase of orthotopic liver transplantation (OLT) performed in cirrhotic patients. Two groups of cirrhotic patients who underwent OLT with piggyback technique were compared; one with a PCS ( n = 57) and the other, without PCS ( n = 54). Patients with fulminant hepatitis, retransplantation, portal thrombosis, and previous portosystemic shunts were excluded. In both groups graft reperfusion was achieved by simultaneous arterial and venous revascularization. Donor, recipient, and surgical characteristics were similar in both groups. The PCS group had a significantly higher portal venous flow (PVF) than the no-PCS group (773 ± 402 mL/min vs 555 ± 379 mL/min, P = .004). Therefore, two subgroups were studied; the high PVF subgroup A (>800 mL/min), mean 1099 ± 261 mL/min, and the low PVF subgroup B (<800 mL/min), mean 433 ± 423 mL/min. Subgroup A, who were treated with PCS, required fewer blood transfusions and displayed better postoperative renal function; whereas, no differences were observed among subgroup B patients with versus without PCS. In conclusion, the use of a temporary PCS with piggyback technique during OLT in cirrhotics has advantages in patients who still maintain a high portal venous flow.