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Venovenous bypass in adult orthotopic liver transplantation: routine or selective use?

Publication ,  Journal Article
Chari, RS; Gan, TJ; Robertson, KM; Bass, K; Camargo, CA; Greig, PD; Clavien, PA
Published in: J Am Coll Surg
June 1998

BACKGROUND: The role of venovenous bypass (VVB) during orthotopic liver transplantation (OLT) remains controversial. The aims of this study were to evaluate the current role of VVB at all major centers in North America, to examine the results of OLT and complications of VVB between two periods with a strict policy for routine versus selective use of VVB, and to review the literature. STUDY DESIGN: A survey of 50 major liver transplant centers was conducted using mailed questionnaires. A retrospective chart review was performed for 547 OLT patients having transplantation during two distinct periods with a strict policy for routine versus selective use of VVB at the University of Toronto, Canada, and at Duke University Medical Center, Durham, North Carolina. The literature was reviewed with a focus on the benefits and indications for routine versus selective use of VVB. RESULTS: Thirty-eight (76%) of 50 centers responded. Sixteen (42%) of them used VVB routinely, with a reported complication rate of 10-30%. Lymphocele and hematoma were the most common complications, but patients having major vascular injury, air embolism, and death were reported. A recent change to selective use of VVB was reported in 30% of the centers (11 of 38). In the Duke-Toronto series, the complication rates were similar between the two periods, at 13.4% and 18.8%, respectively. The outcome of OLT was not influenced by the policy of routine or selective use of VVB. CONCLUSIONS: There is a trend away from the routine use of VVB during OLT. Intraoperative hemodynamic instability during the hepatectomy and a failed trial of hepatic venous occlusion were the most important criteria for using VVB. We conclude that VVB should be used selectively to avoid associated complications and to decrease operative time and costs.

Duke Scholars

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

June 1998

Volume

186

Issue

6

Start / End Page

683 / 690

Location

United States

Related Subject Headings

  • Vena Cava, Inferior
  • Veins
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Portal Vein
  • Male
  • Liver Transplantation
 

Citation

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Chari, R. S., Gan, T. J., Robertson, K. M., Bass, K., Camargo, C. A., Greig, P. D., & Clavien, P. A. (1998). Venovenous bypass in adult orthotopic liver transplantation: routine or selective use? J Am Coll Surg, 186(6), 683–690. https://doi.org/10.1016/s1072-7515(98)00101-x
Chari, R. S., T. J. Gan, K. M. Robertson, K. Bass, C. A. Camargo, P. D. Greig, and P. A. Clavien. “Venovenous bypass in adult orthotopic liver transplantation: routine or selective use?J Am Coll Surg 186, no. 6 (June 1998): 683–90. https://doi.org/10.1016/s1072-7515(98)00101-x.
Chari RS, Gan TJ, Robertson KM, Bass K, Camargo CA, Greig PD, et al. Venovenous bypass in adult orthotopic liver transplantation: routine or selective use? J Am Coll Surg. 1998 Jun;186(6):683–90.
Chari, R. S., et al. “Venovenous bypass in adult orthotopic liver transplantation: routine or selective use?J Am Coll Surg, vol. 186, no. 6, June 1998, pp. 683–90. Pubmed, doi:10.1016/s1072-7515(98)00101-x.
Chari RS, Gan TJ, Robertson KM, Bass K, Camargo CA, Greig PD, Clavien PA. Venovenous bypass in adult orthotopic liver transplantation: routine or selective use? J Am Coll Surg. 1998 Jun;186(6):683–690.
Journal cover image

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

June 1998

Volume

186

Issue

6

Start / End Page

683 / 690

Location

United States

Related Subject Headings

  • Vena Cava, Inferior
  • Veins
  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Portal Vein
  • Male
  • Liver Transplantation