Extracorporeal Circulation in Liver Transplantation

Extracorporeal circulation has recently expanded outside the realm of the traditional cardiac procedures. Extracorporeal circulation and cardiopulmonary bypass has expanded to include: left and right heart long and short term support, systemic and regional hyperthermic perfusion for cancer therapy, systemic rewarming for hypothermia victims due to exposure, repair of aortic tears and aneurysms, support for respiratory failure, and more recently involvement in support of the surgical process for liver transplantation. The first orthotopic liver graft was performed by Starzl and colleagues in 1963 at The University of Colorado at Denver. Then in 1982 Starzl began utilizing veno-veno extracorporeal circulation. Vena-arterial bypass has also been utilized in other centers. Presently, the use of extracorporeal circulation in liver transplantation is being implemented in an increasing number of centers. There have been a wide range of benefits with the use of extracorporeal circulation in liver transplantation. These benefits are the control of the systemic and perihepatic circulation, greater control of volume status through efficient rapid infusion systems and decreased morbidity and mortality. The increased confidence gained by the use of extracorporeal circulation, enables patients to be referred for transplant surgery at an earlier stage, with a more reasonable prospect for a successful surgery.