The delay of rearterialization after initial portal reperfusion in living donor liver transplantation significantly determines the development of microvascular graft dysfunction.
OBJECTIVE
Graft reperfusion in liver transplantation is usually performed by initial portal reperfusion (IPR) and delayed rearterialization. Its influence on graft microcirculation is unknown. This study aimed to assess sinusoidal perfusion in dependence to this reperfusion technique during human living-donor liver transplantation.


METHODS
Hepatic microcirculation was measured both in the donor and the recipient (n=14) by using the orthogonal polarization spectral imaging technique. By using initial portal reperfusion, the mean time interval between portal venous and hepatic arterial reperfusion was 27.7+/-13.3 min.


RESULTS
Hepatic nutritive perfusion, as given by the functional sinusoidal density and the volumetric blood flow, was found significantly decreased during portal reperfusion when compared to baseline. Rearterialization resulted in hyperperfusion of individual sinusoids at a decreased density of the sinusoidal network. Interestingly, the time interval between portal venous and hepatic arterial reperfusion significantly correlated with the changes of the liver grafts' microcirculation.


CONCLUSIONS
The study indicates graft microcirculatory dysfunction as a major determinant of postischemic liver injury. Moreover, microvascular impairment was significantly influenced by the interval between portal venous and hepatic arterial reperfusion, which suggests the reinforcement of the pathomechanism of injury involving hypoxia and rapid graft rewarming due to initial portal reperfusion.
Puhl
Gero
G
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. gero.puhl@charite.de
Schaser
Klaus-D
KD
Pust
Daniel
D
Köhler
Katrin
K
Vollmar
Brigitte
B
Menger
Michael D
MD
Neuhaus
Peter
P
Settmacher
Utz
U
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001810:Blood Volume; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000201:enzymology / Q000503:physiopathology*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011169:Portal Vein; D011184:Postoperative Period; D012039:Regional Blood Flow; D015424:Reperfusion / Q000009:adverse effects / Q000379:methods*; D015427:Reperfusion Injury / Q000209:etiology; D013997:Time Factors
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase