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Portal hyperperfusion after major liver resection and associated sinusoidal damage is a therapeutic target to protect the remnant liver

Journal article
Authors A. Kohler
Per Werner Möller
S. Frey
P. Tinguely
D. Candinas
D. Obrist
S. M. Jakob
G. Beldi
Published in American Journal of Physiology-Gastrointestinal and Liver Physiology
Volume 317
Issue 3
Pages G264-G274
ISSN 0193-1857
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages G264-G274
Language en
Links dx.doi.org/10.1152/ajpgi.00113.2019
Keywords hepatic arterial buffer response, hepatic hemodynamics, liver injury, liver resection, portal flow, arterial blood-flow, hepatic resection, vein ligation, regeneration, hepatectomy, expression, hypertrophy, signal, cells, Gastroenterology & Hepatology, Physiology
Subject categories Physiology, Gastroenterology and Hepatology

Abstract

Extended liver resection results in loss of a large fraction of the hepatic vascular bed, thereby causing abrupt alterations in perfusion of the remnant liver. Mechanisms of hemodynamic adaptation and associated changes in oxygen metabolism after liver resection and the effect of mechanical portal blood flow reduction were assessed. A pig model (n = 16) of extended partial hepatectomy was established that included continuous observation for 24 h under general anesthesia. Pigs were randomly separated into two groups, one with a portal flow reduction of 70% compared with preoperative values, and the other as a control (n = 8, each). In controls, portal flow [mean (SD)] increased from 74 (8) mL.min(-1).100 preoperatively to 240 (48) mL.min(-1).100 g(-1) at 6 h after resection (P < 0.001). Hepatic arterial buffer response was abolished after resection. Oxygen uptake per unit liver mass increased from 4.0 (1.1) mL.min(-1) .100 g preoperatively to 7.7 (1.7) mL.min(-1) .100 g(-1) 8 h after resection (P = 0.004). Despite this increase in relative oxygen uptake, total hepatic oxygen consumption (Vo(2)) was not maintained, and markers of hypoxia and anaerobic metabolism were significantly increased in hepatocytes after resection. Reduced postoperative portal flow was associated with significantly decreased levels of aspartate aminotransferase and bilirubin and increased hepatic clearance of indocyanine green. In conclusion, major liver resection was associated with persistent portal hyperperfusion, loss of the hepatic arterial buffer response, decreased total hepatic (V) over doto(2) and with increased anaerobic metabolism. Portal flow modulation by partial portal vein occlusion attenuated liver injury after extended liver resection. NEW & NOTEWORTHY Because of continuous monitoring. the experiments allow precise observation of the influence of liver resection on systemic and local abdominal hemodynamic alterations and oxygen metabolism. Major liver resection is associated with significant and persistent portal hyperperfusion and loss of hepatic arterial buffer response. The correlation of portal hyperperfusion and parameters of liver injury and dysfunction offers a novel therapeutic option to attenuate liver injury after extended liver resection.

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