[Liver transplantation with preservation of portacaval flow: comparison with the conventional technique]

A modified technique of liver transplantation was used in 46 adults. This technique consisted of: a) construction of a temporary end-to-side porto-caval shunt, b) total hepatectomy with preservation of the inferior vena cava, c) closure of the graft inferior vena cava at both ends, d) partial clamping of the recipient's inferior vena cava followed by side-to-side cavocaval anastomosis, e) suppression of the temporary porto-caval shunt with completion of the operation according to the conventional technique. The results obtained with this technique were compared to those of 40 transplantations performed with the conventional technique. The use of veno-venous extracorporeal circulation was able to be avoided in every case with the modified technique, but was necessary in 70% of cases with the conventional technique. A significant reduction of the operating time (7.2 vs 9.3 hours) and transfusional requirements (11.4 vs 20.3 units of packed cells) was observed. The principal characteristic of this technique was the haemodynamic stability of the patients throughout the operation. These results suggest that this technique is an reliable and effective alternative to the use of veno-venous extracorporeal circulation during liver transplantation in adults.