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BIBTEX RIS

Randomized trial comparing pulmonary alterations after conventional with venovenous bypass versus piggyback liver transplantation

2004; Lippincott Williams & Wilkins; Volume: 10; Issue: 3 Linguagem: Inglês

10.1002/lt.20067

1527-6473

Maria Rita Montenegro Isern, Paulo Celso Bosco Massarollo, Eliane Maria de Carvalho, Carlos Eduardo Sandoli Baía, Jorge Kavakama, Poliana de Andrade Lima, Sérgio Mies,

Liver Disease and Transplantation

During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is cross-clamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixty-seven patients were randomized for conventional VVB (n = 34) or piggyback (n = 33) LT. Pulmonary static compliance (Cst) and PaO2/FIO2 ratio were measured pre- and post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre- and post-LT Cst were 73.4 ± 36.0 mL/cm H2O and 59.7 ± 22.0 mL/cm H2O in the conventional group and 69.1 ± 20.0 mL/cm H2O and 58.7 ± 27.1 mL/cmH2O in the piggyback group. The difference between the two groups was not significant (P = .702). Cst significantly decreased after LT (P = .008). The pre- and post-LT PaO2/FIO2 were 455.6 ± 126.6 mm Hg and 463.1 ± 105.9 mm Hg in the conventional group and 468.9 ± 114.1 mm Hg and 483.3 ± 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P = 0.331). There was no significant difference after LT (P = .382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P = .025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method. (Liver Transpl 2004;10:425–433.)