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Gastroenterology Research and Practice
Volume 2015, Article ID 967951, 7 pages
http://dx.doi.org/10.1155/2015/967951
Research Article

Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass—Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program

1Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
2Department of Anaesthesiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
3Department of Internal Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

Received 29 October 2014; Revised 25 January 2015; Accepted 25 January 2015

Academic Editor: John N. Plevris

Copyright © 2015 Anne Mossdorf et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.