Emergent Liver Transplantation to Salvage a Hepatic Avulsion Injury With a Disrupted Suprahepatic Vena Cava

Liver transplantation offers the last chance to salvage a patient with an irreparable liver injury. We report a case with hepatic avulsion and disruption of the suprahepatic vena cava that could not be repaired by conventional methods. General circulation was restored during the anhepatic phase with an end-to-end portacaval shunt, and a Gott tube (heparin coated) was interposed between the right femoral vein and right atrium. The total anhepatic phase lasted about 20 hours. The graft functioned well even though the patient died of herpes simplex virus infection 25 days postoperatively. While the patient was waiting for the donor, we used a quick and effective approach to maintain the patient's condition. (Arch Surg. 1993;128:1075-1077).