Johnson M W, Powelson J A, Auchincloss H, Delmonico F L, Cosimi A B
General Surgery Services, Massachusetts General Hospital, Boston 02114, USA.
Clin Transplant. 1996 Apr;10(2):181-5.
The use of veno-venous bypass (VVB) during the anhepatic phase of orthotopic liver transplantation (OLT) remains controversial. We employ VVB on a selective basis: patients who tolerate intra-operative supra-hepatic IVC test cross-clamping undergo OLT without VVB while patients who, despite maximal volume resuscitation, develop hemodynamic instability during test cross-clamping, undergo OLT with VVB. The records of 150 adult orthotopic liver allograft recipients transplanted at the Massachusetts General Hospital from January 1984 to December 1994 were reviewed to identify any potential adverse affects on peri-operative, 6 months, 1 year outcomes in recipients foregoing VVB during liver transplantation. Thirty-eight patients (25%) underwent OLT without VVB with actuarial survivals of 78.4% and 69% at 6 months and 1 year. 112 patients (75%) underwent OLT with VVB with actuarial survivals at 6 months and 1 year of 73% and 72%. Demographic data, UNOS status, and diagnoses were similar in each group. There were no significant differences in intra-operative PRBC requirements; lengths of hospital stay; retransplantation rates; or 30 day, 6 months and 1 year survivals between these two groups. There was no significant difference in renal function as determined by preoperative, peak post-operative, discharge serum creatinine levels, or number of patients requiring HD between these two groups. There were two major complications (1.8%) possibly resulting from VVB. In conclusion, patients who tolerate IVC test cross-clamping can safely undergo orthotopic liver transplantation without veno-venous bypass. In our experience, there were no significant differences in peri-operative parameters, post-operative renal function, or short-term survival when compared to patients who, due to hemodynamic instability during IVC cross-clamping, underwent OLT with VVB. Given the potential complications associated with VVB, we feel that in those patients who tolerate intra-operative IVC cross-clamping, it is better to proceed without the use of VVB.
在原位肝移植（OLT）的无肝期使用静脉-静脉转流（VVB）仍存在争议。我们在选择的基础上使用VVB：能耐受术中肝上腔静脉试验性交叉阻断的患者在无VVB的情况下接受OLT，而尽管进行了最大量的容量复苏，但在试验性交叉阻断期间出现血流动力学不稳定的患者则在有VVB的情况下接受OLT。回顾了1984年1月至1994年12月在马萨诸塞州总医院接受移植的150例成人原位肝移植受者的记录，以确定在肝移植过程中未进行VVB的受者在围手术期、6个月、1年结局方面的任何潜在不良影响。38例患者（25%）在无VVB的情况下接受了OLT，6个月和1年的精算生存率分别为78.4%和69%。112例患者（75%）在有VVB的情况下接受了OLT，6个月和1年的精算生存率分别为73%和72%。每组的人口统计学数据、UNOS状态和诊断相似。两组在术中红细胞悬液需求量、住院时间、再次移植率或30天、6个月和1年生存率方面无显著差异。两组之间根据术前、术后峰值、出院时血清肌酐水平或需要血液透析的患者数量所确定的肾功能无显著差异。有两例主要并发症（1.8%）可能由VVB导致。总之，能耐受腔静脉试验性交叉阻断的患者可以在无静脉-静脉转流的情况下安全地接受原位肝移植。根据我们的经验，与因腔静脉交叉阻断期间血流动力学不稳定而在有VVB的情况下接受OLT的患者相比，在围手术期参数、术后肾功能或短期生存率方面无显著差异。鉴于与VVB相关的潜在并发症，我们认为对于那些能耐受术中腔静脉交叉阻断的患者，不使用VVB进行手术更好。
