Systemic and regional hemodynamics in pigs with acute liver failure and the effect of albumin dialysis.
OBJECTIVE
Acute liver failure (ALF) is haemodynamically characterized by a hyperdynamic circulation. The aims of this study were to investigate the systemic and regional haemodynamics in ALF, to measure changes in nitric oxide metabolites (NOx) and to evaluate whether these haemodynamic disturbances could be attenuated with albumin dialysis.


METHODS
Norwegian Landrace pigs (23-30 kg) were randomly allocated to groups as controls (sham-operation, n = 8), ALF (hepatic devascularization, n = 8) and ALF + albumin dialysis (n = 8). Albumin dialysis was started 2 h after ALF induction and continued for 4 h. Systemic and regional haemodynamics were monitored. Creatinine clearance, nitrite/nitrate and catecholamines were measured. A repeated measures ANOVA was used to analyse the data.


RESULTS
In the ALF group, the cardiac index increased (PGT < 0.0001), while mean arterial pressure (PG = 0.02) and systemic vascular resistance decreased (PGT < 0.0001). Renal resistance (PG = 0.04) and hind-leg resistance (PGT = 0.003) decreased in ALF. There was no difference in jejunal blood flow between the groups. ALF pigs developed renal dysfunction with increased serum creatinine (PGT = 0.002) and decreased creatinine clearance (P = 0.02). Catecholamines were significantly higher in ALF, but NOx levels were not different. Albumin dialysis did not attenuate these haemodynamic or renal disturbances.


CONCLUSIONS
The haemodynamic disturbances during the early phase of ALF are characterized by progressive systemic vasodilatation with no associated changes in metabolites of NO. Renal vascular resistance decreased and renal dysfunction developed independently of changes in renal blood flow. After 4 h of albumin dialysis there was no attenuation of the haemodynamic or renal disturbances.
Ytrebø
Lars M
LM
Department of Digestive Surgery, University Hospital Northern Norway, Tromsø, Norway.
Sen
Sambit
S
Rose
Christopher
C
Davies
Nathan A
NA
Nedredal
Geir I
GI
Fuskevaag
Ole-Martin
OM
Ten Have
Gabrie A M
GA
Prinzen
Frits W
FW
Williams
Roger
R
Deutz
Nicolaas E P
NE
Jalan
Rajiv
R
Revhaug
Arthur
A
D000418:Albumins / Q000494:pharmacology*; D000465:Algorithms; D000704:Analysis of Variance; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000097:blood; D003404:Creatinine / Q000097:blood*; D004195:Disease Models, Animal; D005260:Female; D006530:Hepatorenal Syndrome / Q000097:blood; D017114:Liver Failure, Acute / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D009566:Nitrates / Q000097:blood; D009573:Nitrites / Q000097:blood; D011897:Random Allocation; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods; D013552:Swine; D014655:Vascular Resistance / Q000187:drug effects
D000418:Albumins; D002395:Catecholamines; D009566:Nitrates; D009573:Nitrites; D003404:Creatinine