Portal perfusion through the splenic vein during liver procurement

Objectives: Livers procured via donation after cardiac death have produced good outcomes. Some centers use only aortic perfusion; others add portal perfusion. Materials and Methods: We report a series of organ procurements in which portal perfusion was performed via cannulation of the splenic vein instead of the inferior mesenteric vein in 4 donors after cardiac death and 2 donors after brain death. Results: After declaration of death, donors were brought to the operating room and prepared and draped. During procurement, first the aorta was cannulated, and then the atrium or inferior vena cava was opened and perfusion was started. The spleen was mobilized, the splenic vein was dissected out and cannulated, and portal perfusion was performed with 2 L of University of Wisconsin solution. Five liver allografts were transplanted: 3 at our center, and 2 at outside centers. One liver from a donor after cardiac death was declined because of a high fat content. All 5 transplanted grafts showed good initial function; there was no sign of primary nonfunction, and no vascular or biliary complications developed. Conclusions: For livers from donors after cardiac death, cannulation of the splenic vein was easier than access via the inferior mesenteric vein. For donors after brain death, we also found this technique was suitable for livers with intra-abdominal adhesions or a small inferior mesenteric vein. Graft outcomes in this series were excellent.