Related Experiment Video
Updated: Aug 16, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Fatal haemothorax following large-bore percutaneous cannulation before liver transplantation
1Department of Anaesthesia, St James's University Hospital, UK. zorica.jankovic@leedsth.nhs.uk
Insights
A rare complication of veno-venous bypass (VVBP) during liver transplantation occurred when a catheter perforated the pleural space, causing cardiac arrest. This case highlights critical safety concerns during orthotopic liver transplantation procedures.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Critical Care Medicine
Background:
- Percutaneous veno-venous bypass (VVBP) is standard for orthotopic liver transplantation (OLT).
- Known risks include bleeding, vascular/nerve injury, and lymphatic leakage.
- Catheter malposition is an under-recognized but potentially catastrophic complication.
Observation:
- Difficulties were encountered during percutaneous bypass catheterization in an OLT patient.
- The patient experienced cardiac arrest immediately upon initiating VVBP.
- Post-mortem examination identified the bypass catheter tip within the pleural space.
Findings:
- The misplaced catheter resulted in a large right haemothorax.
- Vascular perforation was confirmed as the cause of the haemothorax and cardiac arrest.
- This indicates a significant risk of intrathoracic vessel injury during VVBP catheterization.
Implications:
- Highlights the critical need for precise catheter placement during VVBP for OLT.
- Suggests a review of current techniques and imaging guidance for bypass catheter insertion.
- Emphasizes the importance of prompt recognition and management of potential vascular injuries in OLT patients.
Abstract:
Percutaneous bypass catheters are routinely used for veno-venous bypass (VVBP) during orthotopic liver transplantation (OLT). The recognized risks include bleeding, injury of vascular and nerve structures and lymphatic leakage. We describe a case where there were difficulties during catheterization and the patient suffered a cardiac arrest on commencing VVBP. Post-mortem examination revealed the bypass catheter tip in the pleural space and a large right haemothorax. Possible mechanisms of vascular perforation and preventative measures are discussed.
