New Technique Reduces Time, Risk For Liver Transplants

Liver transplant surgeons at Ohio State have adopted the new procedure, which results in substantially less time for patients to be under anesthetic and conserves the use of donor blood products.

The technique involves rerouting the blood flow in the inferior vena cava, a major vein that carries deoxygenated blood from the liver and other parts of the body back to the heart.

Reconnecting the vena cava and other tiny vessels to restore blood flow to the newly transplanted liver is one of the more tedious tasks encountered during an 8-to-12-hour transplant surgery, according to Dr. Elmahdi Elkhammas who, along with OSU transplant surgeon Mitchell Henry, began developing the more streamlined technique in the late '90s.

"The vessels we are working with are not only very small but, in many cases, as with the vena cava, positioned in a way that makes reconnection difficult after the liver is in place," said Elkhammas.

The method developed at Ohio State allows surgeons to perform some of this more detailed and time-consuming work before the donor liver is placed in the abdomen. The new technique shaves about an hour and one-half off the surgery time and reduces the amount of blood used by about 25 percent as compared to the traditional transplant procedure.

Elkhammas and Henry surgically reconstruct the vena cava and make small portals in the vessels' walls which, when sewn together, create a new channel for the blood flow. The portals are positioned by the surgeon to make it easier to complete the transplant, according to Elkhammas. "The old method of joining the ends of the vena cava was complicated by the positioning of the veins behind the liver," he added.

"We get the same excellent results by rerouting the blood flow," said Elkhammas. "In addition, the patient spends less time under anesthetic and recover more quickly, and we're able to save from three to five units of blood products per surgery."

Elkhammas said variations of this procedure are now being used by a small number of surgeons. Currently, Elkhammas and Henry are compiling data from their use of the technique in more than 140 transplant operations to share with colleagues across the country. Along with other advantages, they have found the one-year survival rate for patients on whom they have performed liver transplants continues to mirror the national average of 80 to 85 percent.

The Ohio State University Medical Center is central Ohio's only solid organ transplant center. With more than 30 years of experience, the OSU program performs more than 250 solid organ transplants annually including kidney, liver, pancreas, kidney/pancreas, lung and heart.