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Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation
Author(s) -
Neelakanta Gundappa,
Colquhoun Steven,
Csete Marie,
Koroleff Dimitri,
Mahajan Aman,
Busuttil Ronald W.
Publication year - 1998
Publication title -
liver transplantation and surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1074-3022
DOI - 10.1002/lt.500040610
Subject(s) - medicine , cryoprecipitate , orthotopic liver transplantation , hemodynamics , anesthesia , hypothermia , cardiopulmonary bypass , liver transplantation , fresh frozen plasma , surgery , transplantation , platelet
Hypothermia during orthotopic liver transplantation (OLT) is common despite measures to prevent this complication. We retrospectively analyzed two groups of patients; those managed with (n = 113) or without (n = 109) a heat exchanger (HE) incorporated in the venovenous bypass (VVB) circuit to test the hypothesis that normothermia before liver reperfusion minimizes hypotension during reperfusion and decreases neohepatic transfusion requirements. Use of the HE resulted in significantly warmer patients during reperfusion and at the end of surgery ( P < .001). An increase in neohepatic transfusion requirement was observed in patients with HE use: packed red blood cells, 4 ± 4 versus 3 ± 3 units; fresh‐frozen plasma, 5 ± 5 versus 4 ± 4 units; platelets, 8 ± 8 versus 6 ± 7 units; and cryoprecipitate, 5 ± 7 versus 3 ± 5 units. There was no difference between the two groups in the untoward hemodynamic events during reperfusion of the liver ( P = .31). We conclude that during OLT, the use of an HE in a nonheparinized VVB circuit helps maintain normothermia. Our limited experience suggests that its use is safe but does not improve hemodynamic stability during reperfusion or decrease blood loss during the neohepatic period.