Canine orthotopic liver transplantation--is systemic veno-venous shunting necessary?

The experience of a single operating team performing the first 30 consecutive orthotopic liver transplants in dogs is reported. In 22 experiments during the anhepatic phase and as the liver graft is inserted in the recipient animal, the portal circulation is protected by a shunt to the jugular vein. Nine dogs survived 2-17 days. In 8 other unselected animals, both the portal vein and the infrahepatic vena cava were shunted to the jugular vein. Although blood pressure was better maintained in animals with 2 shunts, only one dog survived 10 days. Mention is also made of 11 subsequent transplant operations using a single porta-jugular shunt but reducing operating time by having 2 surgeons working on the donor and recipient animal simultaneously. Nine of the 11 dogs survived 2-6 days after the liver transplantation. The survival figures are comparable to those of other centres where double shunting is routinely performed. Our experience suggests that systemic veno-venous shunt may be omitted if the transplant procedure is performed expeditiously.