'No touch' donor hepatectomy, oxygenated 'extracellular' preservation fluids, and arterialization of the portal vein for liver transplantation

Perioperative mortality for liver transplantation remains in the 6% to 30% range, the major causes of death being hepatic failure, hemorrhage, and operative/technical factors. We report here methods that we believe reduce these perioperative dangers. We conclude that the methods detailed here offer effective avoidance of serious organ damage during donor hepatectomy or preservation. They result in reduced allograft ischemic interval, reduced recipient anhepatic time, and avoidance of blood loss together with minimal hemodynamic, biochemical, or acid-base changes at the time of revascularization. In addition they allow the surgeon to perform and test all anastomoses individually without time constraints and to deal with unexpected complications while good early graft function is assured.