Veno-venous bypass versus no bypass in orthotopic liver transplantation: hemodynamic, metabolic, and renal data

Conventional orthotopic liver transplantation (OLT) requires removal of the native liver with the retrohepatic inferior vena cava (IVC) and cross-clamping of the portal vein which is not well tolerated by some patients with important hemodynamic and metabolic disturbances. [1] and [2] In such instances, veno-venous extracorporeal bypass (VVB) or veno-arterial bypass was proposed in order to limit these disorders. [3] and [4] Iatrogenic complications have been described with the use of VVB1 and attempts have been made to develop other surgical techniques. Original techniques of hepatectomy with IVC preservation and partial vena caval occlusion have been developed, like the piggyback technique described by Tzakis et al5 and the side-to-side caval anastomosis technique described by Belghiti et al6; these procedures reduced the need for VVB.