Advantages of Venous Bypass During . Orthotopic Transplantation of the Uver BYERS

The anhepatic phase of an orthotopic: liver transplantation procedure occun when the surgeon has removed the native liver (along with the intrahepatic: portion of the vena cava) and is involved in sewing in the donor organ. During this interval. the inferior vena cava is c:ross-clamped at the diaphragm and at a point just above the entry of the renal veins. The result is a complete interruption of venous return from the inferior vena cava. u is evident from a sudden decrease in both central venous and pulmonary arterial wedge pressures, resulting . in a profound reduction of cardiac: output. I The portal vein is also c:lamped. of necessity. during this phase. A sudden and marked inc:rase in hydrostatic: pressure in both the portal and systemic: venous beds thus occ:un. This not only causes damage to the kidneys, bowel. and pancreas. but also can profoundly exacerbate hemorrhage from the tissues that were cut during the recipient hepatectomy.