Technique in orthotopic liver transplantation (OLT) consists of total excision of retrohepatic inferior vena cava (IVC) during native hepatectomy. Clamping of the IVC above renal veins without veno-venous bypass (VVB) causes renal hemodynamic changes. There is controversy over the influence of standard technique without VVB on the postoperative renal function. The objective of this study is evaluation of the effect of hepatectomy technique on the postoperative renal function. From 253 cases of OLT between June 2006 and July 2008 in Shiraz transplant unit, only 15 cases (5.9%, 10 male, 5 female, 38.07 ± 11.69 y/o) operated by standard technique without VVB. Patient demographics, factors including cold ischemic time (CIT), warm ischemic time (WIT), operative time, transfusions, blood loss, and early postoperative renal function were assessed retrospectively. Criteria for acute renal failure were serum creatinine (Cr) >1.5 mg/dL, an increase in baseline serum Cr by 50%, or oliguria requiring renal replacement therapy (RRT). The cause of end stage liver disease was cryptogenic cirrhosis in 4, hepatitis B in 3, autoimmune hepatitis in 3, primary sclerosing cholangitis in 2, hepatitis C in 2 and Budd-Chiari Syndrome in 1. All patients received liver from deceased donor and none of them required venovenous bypass during the operation. Minimum mean arterial blood pressure of the patients during clamping was 75 ± 19 mmHg. Mean preoperative plasma Cr was 0.99 ± 0.45 mg/dl. During the first week after transplantation 7 patients (46.6 %) developed ARF, and 3 of which required RRT. 4 of the patients died 1 from adult respiratory distress syndrome, 2 from sepsis and 1 from recurrent cholangiocarcinoma after 3 months. In all other patients the plasma Cr returned to normal after 3 weeks and during the follow-up period (6.55 ± 3.10 months). In conclusion, the use of classic technique without VVB for OLT may increase the rate of postoperative renal failure but this complication is mostly reversible in the short-term follow-up.
Volume : 6
Issue : 4
Pages : 118
Shiraz Transplant Center, Namazi Hospital, and Transplant Research Center Shiraz University of Medical Science, Shiraz, Iran