[Induction of impaired hepatic microcirculation by in situ hilus preparation in liver explantation].
OBJECTIVE
Usually, in-situ preparation of the hepatic hilar structures is performed prior to the perfusion with preservation solution. Aim of this study was to investigate mechanical effects of liver preparation on the hepatic microcirculation.


METHODS
16 pigs (German landrace) were randomized in two groups. In both groups, laparotomy was performed after intratracheal intubation. Subsequently, a thermal diffusion probe was implanted into the medial left liver lobe for quantification of microperfusion. In group A (n = 8), bile duct, hepatic artery, and portal vein were exposed and the lesser omentum transsected thereafter. Ultrasound-volume-probes were placed around the hepatic artery and portal vein. Simultaneous measurement of hepatic microperfusion and total liver blood flow was performed five minutes after the end of liver preparation. In group B (n = 8) hepatic microperfusion was quantified 45 minutes after laparotomy without further manipulations.


RESULTS
By the preparation, liver perfusion was significantly reduced in group A from 78 +/- 13 ml/100g/min to 61 +/- 16 ml/100g/min. After preparation a total liver blood flow of 137 +/- 46 ml/100g/min was recorded indicating a shunt fraction of 51 +/- 21%. In contrast, hepatic microperfusion in group B remained at baseline during the whole observation period (79 +/- 3 ml/100g/min vs. 78 +/- 5 ml/100g/min).


CONCLUSIONS
In-situ liver preparation induces a relevant disturbance of hepatic microcirculation. Preservation perfusion shortly after surgical manipulation could become ineffective because of an increase in shunt flow. If the regeneration period is too short, e.g. lack of heart explantation, the quality of the liver graft could be limited.
Klar
E
E
Abteilung für Allgemeine Chirurgie, Unfallchirurgie und Poliklinik, Ruprecht-Karls-Universität Heidelberg.
Kraus
T
T
Osswald
B R
BR
Bleyl
J
J
Fernandes
L
L
Mehrabi
A
A
Newman
W
W
Gebhard
M M
MM
Herfarth
C
C
Otto
G
G
D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D006498:Hepatectomy / Q000379:methods*; D007511:Ischemia / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000502:physiology*; D008833:Microcirculation / Q000503:physiopathology; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion; D013552:Swine
Induktion einer hepatischen Mikrozirkulationsstörung durch In-situ-Hiluspräparation bei Leberexplantation.