Auxiliary heterotopic liver transplantation.

Orthotopic liver transplantation is now an accepted form of treatment for end-stage liver disease. However, the operative procedure is a major undertaking, often associated with considerable blood loss during the dissection of the diseased host liver with many collaterals in the presence of portal hypertension. In the anhepatic phase interruption of the portal and vena cava flow results in a decrease in venous return; for that reason many centers use a venovenous bypass system to prevent a serious drop in cardiac output and hypotension. Finally, if the graft fails to function fully in the immediate postoperative period or in the following months, the patient must be urgently retransplanted or will die. The magnitude of the surgical procedure of orthotopic liver transplantation restricts its use to patients who are in relatively stable condition with regard to synthesis of clotting factors as well as cardiopulmonary and nutritional status.