title: Synergistic effects of brain death and liver steatosis on the hepatic microcirculation.
abstract: BACKGROUND
  The routine transplantation of steatotic livers could potentially mitigate the donor shortage, but so far is associated with a high rate of graft dysfunction. Steatosis and brain death have been perceived as independent risk factors, but they may synergistically target the hepatic microcirculation. This study compares the effects of brain death on the microcirculation of steatotic and normal livers.
  
  
  METHODS
  Brain death was induced in obese and lean Zucker rats. Lean and obese sham-operated animals served as controls. Liver microcirculation was investigated using intravital fluorescence microscopy. Serum liver enzyme and reduced glutathione, expression of P-selectin, ICAM-1 and VCAM-1 mRNA in the liver were determined. The ultrastructural alterations were compared by electron microscopy.
  
  
  RESULTS
  In nonbrain-dead animals, liver steatosis was associated with smaller sinusoidal diameters, but did not impair sinusoidal perfusion. During brain death, sinusoidal diameter and perfusion were reduced in normal and, to a greater extent, in steatotic livers. Also, more leukocytes were recruited to the microvasculature of steatotic livers than to normal livers in brain-dead state. The highest liver enzyme activities and the lowest hepatic GSH concentrations were measured in brain-dead animals with steatotic livers; only in these organs was endothelial cell swelling regularly observed. In brain-dead state, only the P-selectin mRNA expression was increased in steatotic livers as compared to normal livers.
  
  
  CONCLUSIONS
  Brain death amplifies the adverse effects of steatosis on the hepatic microcirculation. Our results underline the need for therapeutic intervention in brain-dead state when steatotic livers are to be used for transplantation.
authors.affiliation: Institute for Surgical Research, Klinikum Grosshadern, University of Munich, Munich, Germany.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamagami
authors.forename: Jörg
authors.initials: J
authors.lastname: Hutter
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Rolf Josef
authors.initials: RJ
authors.lastname: Schauer
authors.forename: Georg
authors.initials: G
authors.lastname: Enders
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Leiderer
authors.forename: Onur
authors.initials: O
authors.lastname: Ozen
authors.forename: Claus
authors.initials: C
authors.lastname: Hammer
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: Konrad
authors.initials: K
authors.lastname: Messmer
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001926:Brain Death / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D004195:Disease Models, Animal; D005234:Fatty Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D015870:Gene Expression; D018799:Intercellular Adhesion Molecule-1 / Q000235:genetics; D008099:Liver / Q000098:blood supply* / Q000378:metabolism / Q000648:ultrastructure; D008102:Liver Circulation / Q000502:physiology*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008854:Microscopy, Electron; D008856:Microscopy, Fluorescence; D019007:P-Selectin / Q000235:genetics; D012313:RNA / Q000096:biosynthesis / Q000235:genetics; D051381:Rats; D011924:Rats, Zucker; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019010:Vascular Cell Adhesion Molecule-1 / Q000235:genetics
chemical_list: D019007:P-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D012313:RNA