Temporary portocaval anastomosis with preservation of caval flow during orthotopic liver transplantation

Background A novel technique of orthotopic liver transplantation was developed whereby both vena caval and portal venous blood flows are preserved during the entire procedure. Patients and methods This method of liver transplantation was successfully performed in 51 consecutive patients and included a temporary portocaval shunt, a total hepatic resection with vena caval preservation, and an end-to-side cavocaval anastomosis. Results Preservation of vena cava and portocaval anastomosis were feasible in 51 patients (100%), including 34 patients with cirrhosis and 2 patients undergoing elective retransplantation. Both caval and portal flows were preserved during the entire procedure in 48 patients (94%). No venovenous bypass was required. Four deaths (7.8%) occurred postoperatively, all of them unrelated to the surgical procedure. Conclusion We believe adoption of this orthotopic liver transplantation technique will obviate the need for venovenous bypass