Clinical Experience of Side to Side Caval Anastomosis during Orthotopic Liver Transplantation without Inferior Vena Caval Occlusion

Abstract

Background/Aims: The retrocaval dissection, with venous collaterals, is sometimes difficult, making subsequent hemostasis less easy during orthotopic liver transplantation(OLT). We have recently applied a modified technique of vena caval preservation during OLT, and undertook this study to evaluate retrospectively its effects.

Methods: Five patients with liver cirrhosis underwent a modified OLT from March 1999 through July 2001. The procedure includes a side to side anastomosis between the IVC of the donor and the recipient without vena cava occlusion during OLT.

Results: This technique pemitted the avoidance of vena caval occlusion in all cases. We could performed OLT without venovenous bypass in 3 patients who tolerated the temporary portal clamping test before the recipient hepatectomy. As retrocaval dissection was not performed, hemostasis was esier during anhepatic phase. We could reduce anhepatic phase into average 60 minutes from only one caval anastomosis during OLT.

Conclusions: We think this alternative technique, requiring only one caval anastomosis, can reduce the duration of the anhepatic phase and the need for venous bypass.