Korean J Anesthesiol.  2011 Jan;60(1):19-24. 10.4097/kjae.2011.60.1.19.

Experience without using venoveno bypass in adult orthotopic liver transplantation

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea. inyoung_huh@uuh.ulsan.kr
  • 2Department of General Surgery, Ulsan University Hospital, Ulsan, Korea.
  • 3Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, Ulsan, Korea.

Abstract

BACKGROUND
Venoveno bypass (VVB) has been used to achieve hemodynamic stability and decrease the incidence of renal dysfunction. However, VVB has many complications. The purpose of this study is to verify the safety of total clamping of the suprahepatic inferior vena cava (IVC) without VVB during orthotropic liver transplantation (OLT) in terms of anesthetic management.
METHODS
Twenty-five patients without preoperative renal dysfunction who underwent primary OLT were enrolled in this study. Hemodynamic data and blood gas measurements were collected 1 hour after incision, 30 minutes after IVC total clamping and 30 minutes after reperfusion. Postoperative laboratory data, including blood urea nitrogen (BUN), creatinine (Cr) and glomerular filtration rate (GFR), were assessed at postoperative day (POD) 0-7, 30, 90, 180 and 1 year.
RESULTS
Mean blood pressure was well maintained during IVC total clamping with infusion of inotropics. There was no case of severe acidosis (pH < 7.2) during the anhepatic period. The immediate postoperative Cr and GFR were not significantly different from those of the preoperative values. BUN increased from POD 1 and decreased after POD 6, while Cr increased at POD 90 only.
CONCLUSIONS
In patients without preoperative renal dysfunction, when IVC was totally clamped, VVB does not need to be routinely performed to maintain hemodynamics during the anhepatic phase and renal function after OLT.

Keyword

BUN; Creatinine; GFR; IVC total clamp; OLT; VVB
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