Abstract
ABSTRACT
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.
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.