Support perfusion for liver transplantation

Area of Science:

• Cardiovascular Surgery
• Hepatobiliary Surgery
• Transplant Surgery

Background:

• Addenbrooke's Hospital has performed liver transplants since 1968.
• Bypass techniques have been intermittently used since 1977.
• In 1990, 38% of adult liver transplants required bypass, with an additional 25% on standby.

Purpose of the Study:

• To describe the criteria and methods for using bypass in high-risk adult liver recipients.
• To detail the surgical cannulation and bypass system utilized.
• To highlight the benefits of bypass for patient management during liver transplantation.

Main Methods:

• Selection of high-risk adult liver recipients based on surgical and anesthetic criteria.
• Placement of cannulae in jugular and/or brachial veins for volume replacement.
• Femoral and portal vein cannulation for splanchnic venous drainage to a heparin-coated Biomedicus bypass system.

Main Results:

• Bypass provides flows of 1.5 to 2.5 liters per minute.
• Modest perfusion pressures (around 120mmHg) are maintained.
• Adequate surgical venous decompression and circulatory support are achieved during the anhepatic phase.

Conclusions:

• The described bypass technique effectively supports high-risk adult liver transplant recipients.
• This method ensures hemodynamic stability and facilitates surgical venous decompression.
• The routine use of bypass enhances patient benefit and minimizes risk in complex liver transplant cases.