title: Thermodiffusion for continuous quantification of hepatic microcirculation--validation and potential in liver transplantation.
abstract: Hepatic microcirculation is a main determinant of reperfusion injury and graft quality in liver transplantation. Methods available for the quantification of hepatic microcirculation are indirect, are invasive, or preclude postoperative application. The aim of this study was the validation of thermodiffusion in a new modification allowing long-term use in the clinical setting. In six pigs Doppler flowmeters were positioned around the hepatic artery and portal vein for the measurement of total liver blood flow. Liver perfusion was quantified by thermodiffusion and compared to H(2) clearance as an established technique under baseline conditions, during different degrees of portal venous obstruction and during occlusion of the hepatic artery. Thermodiffusion measurements were recorded for five days postoperatively followed by histological evaluation of the hepatic puncture site. Perfusion data obtained by thermodiffusion were significantly correlated to H(2) clearance (r = 0.94, P < 0. 001) and to liver blood flow (r = 0.9, P < 0.05). The agreement between thermodiffusion and H(2) clearance was excellent (mean difference -2.1 ml/100 g/min; limits of agreement -12.5 and 8.3 ml/100 g/min). Occlusion of the portal vein or hepatic artery was immediately detected by thermodiffusion, indicating a decrease of perfusion by 64 +/- 7% or 27 +/- 5% of baseline, respectively. Perfusion values at baseline and during vascular occlusion were reproducible during the entire observation period. Histological changes of the liver tissue adjacent to the thermodiffusion probes were minute and did not influence long-term measurements. In vivo validation proved that enhanced thermodiffusion is a minimally invasive technique for the continuous, real-time quantification of hepatic microcirculation. Changes in liver perfusion can be safely detected over several days postoperatively. The implication for liver transplantation has led to the clinical application of thermodiffusion.
authors.affiliation: Department of Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Klar
authors.forename: T
authors.initials: T
authors.lastname: Kraus
authors.forename: J
authors.initials: J
authors.lastname: Bleyl
authors.forename: W H
authors.initials: WH
authors.lastname: Newman
authors.forename: H F
authors.initials: HF
authors.lastname: Bowman
authors.forename: W J
authors.initials: WJ
authors.lastname: Hofmann
authors.forename: R
authors.initials: R
authors.lastname: Kummer
authors.forename: M
authors.initials: M
authors.lastname: Bredt
authors.forename: C
authors.initials: C
authors.lastname: Herfarth
mesh_terms: D000818:Animals; D004058:Diffusion; D005069:Evaluation Studies as Topic; D006499:Hepatic Artery / Q000502:physiology; D006801:Humans; D006859:Hydrogen / Q000097:blood; D008099:Liver / Q000293:injuries; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D008833:Microcirculation / Q000502:physiology; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011169:Portal Vein / Q000502:physiology; D011677:Punctures / Q000009:adverse effects; D015427:Reperfusion Injury / Q000175:diagnosis / Q000503:physiopathology; D015203:Reproducibility of Results; D013552:Swine
chemical_list: D006859:Hydrogen