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

Kohler, Andreas; Moller, Per Werner; Frey, Sabrina; Tinguely, Pascale; Candinas, Daniel; Obrist, Dominik; Jakob, Stephan; Beldi, Guido (2019). Portal hyperperfusion after major liver resection and associated sinusoidal damage is a therapeutic target to protect the remnant liver. American journal of physiology - gastrointestinal and liver physiology, 317(3), G264-G274. American Physiological Society 10.1152/ajpgi.00113.2019

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Extended liver resection results in the loss of a large fraction of the hepatic vascular bed and thereby abrupt alterations in the 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 that included continuous observation for 24 hours under general anesthesia was established. Pigs were randomly separated into 2 groups, one group with a portal flow reduction of 70% compared to the preoperative values, and the other group as a control (n=8, each). In controls, portal flow [mean (SD)] increased from 74 (8) (ml/min)/100g preoperatively to 240 (48) (ml/min)/100g at 6 hours 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)/100g preoperatively to 7.7 (1.7) (ml/min)/100g 8 hours after resection (p=0.004). Despite this increase in relative oxygen uptake, total hepatic oxygen consumption 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 vO and with increased anaerobic metabolism. Portal flow modulation by partial portal vein occlusion attenuated liver injury after extended liver resection.

Item Type:

Journal Article (Original Article)

Division/Institute:

10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Cardiovascular Engineering (CVE)
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Kohler, Andreas; Frey, Sabrina; Candinas, Daniel; Obrist, Dominik; Jakob, Stephan and Beldi, Guido

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0193-1857

Publisher:

American Physiological Society

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

05 Aug 2019 17:19

Last Modified:

22 Nov 2019 14:19

Publisher DOI:

10.1152/ajpgi.00113.2019

PubMed ID:

31216172

Uncontrolled Keywords:

hepatic arterial buffer response hepatic hemodynamics liver injury liver resection portal flow modulation

BORIS DOI:

10.7892/boris.131666

URI:

https://boris.unibe.ch/id/eprint/131666

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