Outcomes of a Modified Portal Venovenous Bypass Technique During Liver Transplantation in High-MELD Recipients.

BACKGROUND

Although portal (venovenous) bypass (pVVB) is uncommon in liver transplantation (LT), it may provide some advantages, particularly for high-acuity recipients.

METHODS

To examine its use in high-risk patients, we retrospectively evaluated outcomes of a modified pVVB technique among adult LT recipients at a single center, stratified by MELD score (≥35 vs. <35). Primary outcomes were patient and graft survival evaluated withKaplan-Meier estimates and multivariable Cox regression; secondary outcomes included biliary complications, transfusion requirements, viscoelastic parameters, laboratory trends, length of stay, readmission, and need for dialysis.

RESULTS

Between January 2016 and July 2025, 548 patients underwent LT with pVVB; 111 (20.3%) had MELD ≥35. Despite greater baseline severity, higher transfusion requirements, and longer postoperative ICU stay, MELD ≥35 was not associated with increased risk of graft failure (HR 1.19; 95% CI 0.72-1.96), mortality (HR 0.86; 95% CI 0.46-1.61), or biliary complications (HR 1.02; 95% CI 0.65-1.60). Post-reperfusion viscoelastic measures were similar across groups. Dialysis was more frequent before and after LT in MELD ≥35. No complications or deaths were attributable to pVVB.

CONCLUSION

Among LT recipients treated with pVVB, MELD ≥35 was not significantly associated with graft failure, mortality, or biliary complications. These findings support the feasibility of pVVB in high-acuity recipients.