Cavocaval adult liver transplantation and retransplantation without venovenous bypass and without portocaval shunting: a prospective feasibility study in adult liver transplantation

Transplantation
J P LerutJean-Bernard Otte

Abstract

The original method of liver transplantation (LT) included recipient inferior vena cava (IVC) resection and the use of extracorporeal venovenous bypass (VVB). Refinements in technique permit transplantation to be done with IVC preservation and without VVB use. Between November 1993 and November 2000, 202 consecutive grafts were performed in 188 adults (>/=16 years of age). Twelve patients (6.4%) received two and three retransplants (re-LT). Split grafting was performed 19 times (19 of 202 grafts, 9.4%). Risk factors included United Network of Organ Sharing status I (n=30, 16%), previous right upper abdominal surgery (n=32, 17.1%), caudate lobe encirclement of IVC (n=65, 32.2%), IVC (n=24, 11.9%), and splanchnic venous modification (n=58, 30.9%), transjugular intrahepatic portosystemic stent shunt (n=34, 16.8%), giant (>5 kg) liver tumor (n=6, 3%), septic necrosis of the caudate lobe (n=1, 0.5%), and previous cavocaval (n=13, 6.4%) or classical LT (n=5, 2.5%). IVC preservation, avoidance of IVC cross clamping and of VVB use were possible in 98.9%, 93%, and 99.5% of 183 primary LT and in 89.5%, 84.2%, and 89.5% of 19 re-LT. Temporary portocaval shunting was never applied. Perioperative mortality was 1.2%. There was no allotransfu...Continue Reading

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Citations

Jan 23, 2008·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·J SchmidtM W Büchler
Sep 6, 2008·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Hamidreza FonouniJan Schmidt
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Apr 12, 2005·Transplant International : Official Journal of the European Society for Organ Transplantation·Jan LerutPierre Goffette
Jun 24, 2005·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Kalpana ReddyTim Peachey
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Apr 13, 2020·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Pietro AddeoPhilippe Bachellier
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Nov 15, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Julie NavezJan Lerut
Mar 3, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Sophie LarocheMarc Antoine Allard

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