Systemic veno-venous bypass with percutaneous approach in liver transplant: a new appraisal of an old concept

Abstract

Introduction: Veno-venous by-pass(VVBP) has been historically reported in Liver Transplantation(LT) to warrants more hemodynamic stability during surgery and even recently described as a tool to reduce acute kidney injury(AKI) peri operatively.The aim of this study is to present a recent single-center experience on the use of VVBP in LT with two characteristics named systemic only VVBP and percutaneous approach. Methods: A retrospective analysis of a prospectively collected database was conducted on a consecutive series of 130 primary LT performed with standard technique from April 2016 to December 2017 at IRCCS-ISMETT-UPMC. Patients were divided into 2 groups,Group A, 75 patients with Percutaneos Systemic Bypass (PSBP)and Group B 75 patients with No Bypass(NBP).Patient's characteristics, intraoperative vitals monitored, 90 days postoperative mortality and morbidity(recorded using Clavien-Dindo system)are reported in Table 1.The VVBP was in all cases percutaneously realized between left femoral and the left internal jugular vein. Results: The 2 groups were not homogenous because of the clinical conditions prompting the indication for VVBP, that included cardiac diseases, severe portal hypertension, acute liver failure, and failure to tolerate a trial of cross-clamping of the inferior vena cava. No statistically significant differences between the two groups were detected regarding the incidence of AKI, any Clavien grade of complications and severe complications(>IIIb).Patient death occurred in 7 cases (3 and 4 patients in Group A and B, respectively).EP05A-064 TablenOverall (N)Overall (% or SD)Group A (N)Group A (%)Group B (N)Group B (%)pAge (mean (SD))569,14578,60569,660,59Diagnosis: HCC (%)9161476345590,99Charlson index >1 (%)3624223014190,37Meld – ISO score (mean (SD))225,49235,38215,580,35Pret-operative ESRD (%)8534561,00Post-operative ESRD (%)2617141912161,00CIT (mean (SD))45483,3445395,7445571,810,95All complications (Clavien > I) (%)10871567452690,78Severe complications (Clavien > IIIB) (%)8053425638500,80 Open table in a new tab Conclusion: In our experience, the use of PSBP was associated to facilitation to train young surgeons, achieve same outcome despite increase in complexity of the recipients, and optimize intra-operative hemodynamic stability.