test 8 liver transplant procedure

Question 1

Liver transplant process

Answer 1

 Donor Organ usually arrives prior to incision. Organ is prepped at the back table.
 Incision is made, liver is mobilized.
 Test Clamp is performed. If patient remains stable – can do it without V-V bypass. If not, V-V bypass is initiated.
 Liver is excised and removed.
 New Liver is sewn in

Question 2

New liver sewn in what order

Answer 2

 Suprahepatic IVC
 Infrahepatic IVC
 Portal Vein
 Hepatic Artery
 Clamps are removed – Bypass is discontinued
 Bile Duct
- BIG STUFF TO LITTLE STUFF
- take a long break to see if the liver is functioning and creating bile

Question 3

Most common technique of liver transplants

Answer 3

 Less than 5% of liver transplants use V-V Bypass.

 Now they can use a partial occlusion clamp on the IVC without cross clamping the entire IVC

Question 4

Liver Transplant – V-V bypass

Answer 4

 No oxygenator
 Less flows than on CPB
 Flows from 1-2 liters most common
 Flow what you can get
 Femoral vein is cannulated and advanced to the bifurcation of the IVC
 2nd cannula placed in the portal vein to drain the portal system.
 Wyed into the venous line.
 Centrifugal pump
 Return to axillary vein or internal jugular vein.
 No heparin is used
 Flows adequate unless less than 1 liter per minute and cardiac preload is maintained
 Need to maintain flow to prevent clot
 Preload dependent.
 Closed system, so no volume can be added.
- Core temp is important to watch because when the new liver is put in, since it is so large it can cause the heart to be sent into a fibrillation state

Question 5

Liver Transplant – V-V bypass history

Answer 5

 First used by Marshall, Et al in 1970.
 Managed a patient with renal cell carcinoma extending into the IVC and RA
 1960s – realized that they needed a shunt that could train blood from the lower extremities and portal system
 First looked at utilizing bypass without a pump
 Unsuccessful – circuit clotted, and created embolism
 Tried anticoagulation
 Increased bleeding too much
 1980s – V-V Bypass came into practice with the use of heparin bonded circuits and a centrifugal pump.