Sutureless anastomoses using magnetic rings in canine liver transplantation model

Objective Magnetic rings were used for rapid vascular reconstruction in a canine liver transplantation model. Materials and methods Thirty-two adult mongrel dogs weighing 13 to 16 kg were randomly selected as donors or recipients of transplantations. The recipients were randomly divided into two groups: group A (n = 10) had magnetic rings used for vascular reconstruction without venovenous bypass; group B (n = 6) had vascular reconstruction performed by continuous suturing with splenojugular venovenous bypass. Results In group A, the entire operative period was 3.24 ± 0.49 hours, the durations of clamping the portal vein and the infrahepatic vena cava of the recipient were 5.89 ± 2.27 minutes and 3.89 ± 0.73 minutes, respectively. In group B, the entire operative period was 4.12 ± 0.51 hours with the duration of clamping portal vein and infrahepatic vena cava, 28.33 ± 6.04 minutes and 12.16 ± 3.72 minutes (P Conclusion The results showed that the anhepatic time was significantly shortened (about 5.89 ± 2.27 minutes) in group A compared with group B and venovenous bypass was unnecessary. Magnetic rings could be used for rapid vascular reconstruction in canine liver transplantation model. The long-term results of this procedure should be clarified before it is applied in clinical practice in the future.

Novel magnetic rings for rapid vascular reconstruction in canine liver transplantation model.

The objective of this chapter is to present an overview of veno-venous bypass (VVB) for liver transplantation (LT), including its history, benefits and drawbacks. VVB for LT patients was introduced in the 1980s to reduce bleeding and cardiovascular instability during the anhepatic phase. Since then, VVB has been routinely used in the majority of LT centres over two decades. During this period, surgical techniques have evolved and VVB is no longer required in every case. High cost of VVB, the risk of complications from large-bore line insertion and the VVB procedure itself, the risk of hypothermia, and a lack of evidence that it improves LT outcomes additionally contributed to the reduced use of VVB. While VVB may still be indicated in some cases, it is now used in only a small proportion of all LTs. Although ultrasound (US)- and trans-oesophageal echo (TOE)-guided bypass line insertion techniques have been developed over the past two decades has reduced the complications of VVB, new anaesthetic and surgical teams are relatively unfamiliar with these procedures, which may offset their benefits such that the rate of complications is the same as when VVB was routinely used without US guided insertion of bypass lines. This chapter discusses the basic principles of VVB in LT programmes, the history of its use, the main indications, and all reported complications, to educate new generations of anaesthetists who have had little or no exposure to VVB during LT.

Veno-Venous Bypass in Liver Transplantation

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.20482

Venovenous bypass in orthotopic liver transplantation: Time for a rethink?

As previous studies demonstrated conflicting results, we investigated the hemodynamic and renal outcomes of the intra-operative use of a veno-venous bypass during liver transplantation.The intraoperative levels of mean artery pressure, cardiac index, inferior vena cava and renal perfusion pressures were compared in liver transplant patients receiving or not the bypass.We enrolled 38 patients: 20 with the bypass and 18 without. No differences characterized the two groups regarding gender (P=0.95), age (P=0.32), BMI (P=0.09), liver disease indicating LT and preoperative serum creatinine levels. Patients with the bypass received more intraoperative fluids (crystalloids and colloids) but with no difference in terms of intraoperative blood products and vasopressors requirements (P=0.33). After clamping of the inferior vena cava, patients with the bypass showed higher mean artery pressure. Simultaneously, pressure in the inferior vena cava below the clamp level sharply increased vs. baseline (P<0.0001) independently of the use of the bypass and remained high until clamp release. Consequently, renal perfusion pressure dropped abruptly (P<0.0001) after vena cava clamping and returned to baseline only upon clamp removal. Overall, 18 subjects developed postoperative acute kidney injury which was equally distributed between patients with (n=9) or without (N.=8) the bypass.Our data suggest that the use of a veno-venous bypass fails to release the increased renal venous backflow from inferior vena cava clamping resulting in renal congestion with reduced renal perfusion pressure. 

Use of an intraoperative veno-venous bypass during liver transplantation: an observational, single center, cohort study

Background Orthotopic liver transplantation (OLI) is a recognised means of therapy for endstage liver failure (ESLF). Both the preoperative alterations of renal function, closely correlated with the ESLF, and the frequent and abrupt changes of circulating blood volumes occurring during the various phases of OLT are able to significantly alter renal function during the perioperative period. Methods In order to define the specific changes of renal function during the various phases of OLT, six postnecrotic cirrhotic patients undergoing their first OLT entered a prospective study protocol. All the patients had standard and anesthetic techniques including the venovenous bypass (VVBP) during the anhepatic phase. At standard intervals (baseline, during hepatic dissection, during the anhepatic phase, following reperfusion, at the end of surgery) together with complete hemodynamic and metabolic profiles, arterial blood and urine samples were obtained to determine electrolytes and creatinine concentrations, blood levels of atrial natriuretic factor, aldosterone and renin activity. Using standard formulas creatinine clearance (Ccreat) and Na absolute and fractional excretions (FeNa%) were calculated. Results Major changes in the hemodynamic profile occurred during the anhepatic phase in spite of the use of the VVBP (reduced cardiac index, reduced pulmonary wedge pressure, increased systemic vascular resistances). Concomitantly a significant decrease in Ccreat (-67%) and in urinary output, was present while aldosterone and renin activity increased. The changes in Ccreat persisted at the end of surgery in spite of the optimal hemodynamic profile. Aldosterone and renin activity returned to values close to baseline at the end of surgery. Conclusions From these data it is possible to conclude that renal function markedly deteriorates during OLT and it has to be considered at increased risk in the immediate postoperative period. The use of VVBP does not seem to prevent the intraoperative renal impairment.

Evaluation of renal function during orthotopic liver transplantation

A.284 Pharmacokinetic profile of the induction dose of propofol In the burned patients

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Evaluation of renal function during orthotopic liver transplantation

A.284 Pharmacokinetic profile of the induction dose of propofol In the burned patients