Temporary portocaval anastomosis with preservation of caval flow during orthotopic liver transplantation.

ABSTRACT

BACKGROUND: A novel technique of orthotopic liver transplantation was developed whereby both vena caval and portal venous blood flows are preserved during the entire procedure. PATIENTS AND METHODS: This method of liver transplantation was successfully performed in 51 consecutive patients and included a temporary portocaval shunt, a total hepatic resection with vena caval preservation, and an end-to-side cavocaval anastomosis. RESULTS: Preservation of vena cava and portocaval anastomosis were feasible in 51 patients (100%), including 34 patients with cirrhosis and 2 patients undergoing elective retransplantation. Both caval and portal flows were preserved during the entire procedure in 48 patients (94%). No venovenous bypass was required. Four deaths (7.8%) occurred postoperatively, all of them unrelated to the surgical procedure. CONCLUSION: We believe adoption of this orthotopic liver transplantation technique will obviate the need for venovenous bypass.