[Perfusion management in liver transplantation]

Area of Science:

• Cardiovascular Surgery
• Hepatobiliary Surgery
• Transplantation Medicine

Background:

• Orthotopic liver transplantation (OLT) is a complex procedure.
• Maintaining hemodynamic stability and minimizing blood loss are critical during OLT.
• Veno-venous bypass (VVB) is employed to support circulation during the liver-free period.

Purpose of the Study:

• To evaluate the impact of veno-venous bypass (VVB) on hemodynamic and biochemical parameters during orthotopic liver transplantation.
• To assess the efficacy of the Cell-Saver device in preserving autoerythrocytes and minimizing homologous blood transfusion.

Main Methods:

• Veno-venous bypass (VVB) with a Biopump centrifugal pump was utilized in 36 patients undergoing OLT.
• Hemodynamic parameters including volume rate of perfusion (VR), arterial pressure (AP), and central venous pressure (CVP) were monitored.
• Blood loss was quantified by processing collected blood with a Cell-Saver device to measure washed autoerythrocytes.

Main Results:

• VVB facilitated perfusion rates of 1064.2 +/- 87.5 ml/min (femoral-axillary) and 2630.5 +/- 112.3 ml/min (femoral-porto-axillary).
• A transient decrease in mean AP to 65 mm Hg and CVP to 2 mm Hg was noted, with mild tachycardia.
• No significant alterations in acid-base balance, oxygen balance, or electrolytes were observed during the liver-free period. Maximum blood loss occurred during the liver-free period and reperfusion.
• Cell-Saver processing of blood minimized the requirement for donor erythrocytes, preventing transfusion-related complications.

Conclusions:

• Veno-venous bypass (VVB) favorably impacts the course of orthotopic liver transplantation by stabilizing hemodynamic and biochemical parameters.
• VVB effectively prevents abdominal organ ischemia during the liver-free period.
• Autoerythrocyte preservation via Cell-Saver technology significantly reduces homologous blood transfusion needs and associated risks in OLT patients.