The effect of mechanically enhancing portal venous inflow on hepatic oxygenation, microcirculation, and function in a rabbit model with extensive hepatic fibrosis

Authors

  • Long R. Jiao,

    1. Liver Surgery Section, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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  • Alexander M. Seifalian,

    1. Hepatic Haemodynamic Laboratory, University Department of Surgery, Royal Free Hospital and School of Medicine, London, UK
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  • Nagy Habib,

    1. Liver Surgery Section, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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  • Brian R. Davidson M.D.

    Corresponding author
    1. Hepatic Haemodynamic Laboratory, University Department of Surgery, Royal Free Hospital and School of Medicine, London, UK
    • Professor of Hepatobiliary Surgery & Liver Transplantation, University Department of Surgery and Liver Transplantation Unit, Royal Free Hospital and School of Medicine, Pond Street, Hampstead, London NW3 2QG, UK. fax: (44) 171 830 2688
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Abstract

Enhancing the portal venous blood flow (PVBF) has been shown to reduce portal pressure and intrahepatic vascular resistance and to improve liver function in isolated cirrhotic rodent livers in vitro. The aim of this study was to assess the short-term effect of mechanically pumping the portal inflow on hepatic microcirculation (HM), oxygenation, and function in an animal model of extensive hepatic fibrosis. New Zealand white rabbits underwent laparotomy and exposure of the liver: group 1 (n = 7) were normal controls; group 2 (n = 7) had hepatic fibrosis. Total hepatic blood flow (THBF) and HM was measured along with continuous monitoring of intrahepatic tissue oxygenation using near infrared spectroscopy (NIRS). Baseline hepatic hemodynamics and liver function were measured in both groups. PVBF was then increased by 50% over a 3-hour period in the hepatic fibrosis group using a miniature portal pump designed for human implantation, and the hemodynamics were monitored continuously. Liver function tests were repeated after portal pumping. In comparison with normal controls, animals with hepatic fibrosis had a higher portal pressure (13.0 ± 3.6 vs. 3.7 ± 1.4 mm Hg, P < .001, mean ± SD vs. controls), reduced PVBF (52.4 ± 24.6 vs. 96.9 ± 21.1 mL/min, P = .003), and increased portal vascular resistance (P = .001). THBF and flow in the HM was lower than in controls, and liver function tests were abnormal. After a 3-hour period of enhanced portal flow in animals with hepatic fibrosis, the portal pressure greatly reduced (13.0 ± 3.6 to 2.5 ± 1.1 mm Hg, P < .001) as did the intrahepatic portal resistance (0.32 ± 0.18 to 0.04 ± 0.03 mm Hg/mL/min, P = .006). Flow in the HM improved (143 ± 16 to 173 ± 14 flux units, P = .006) and was associated with improved hepatic tissue oxygenation, tissue oxy-hemoglobin (HbO2 ) and cytochrome oxidase being increased by 24.4 ± 7.5 and 5.65 ± 2.30 μmol/L above the baseline value (P < .001), respectively. A 3-hour period of mechanical portal pumping produced a dramatic improvement in liver function, bilirubin (41.1 ± 25.9 to 10.0 ± 5.9 μmol/L, P = .040), aspartate transaminase (AST) (135.5 ± 52.3 to 56.3 ± 19.8 U/L, P = .006) and lactate dehydrogenase (LDH) (2,030.1 ± 796.3 to 1,309.8 ± 431.6 IU/L, P = .006; prepumping vs. postpumping, all P < .050). In conclusion, portal pumping in this rabbit model with extensive hepatic fibrosis improved liver parenchymal perfusion, oxygenation, and function.

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