A. Gadano et al., STUDIES OF PORTAL HEMODYNAMICS AND HEPATIC OXYGEN-CONSUMPTION DURING ACUTE LIVER ALLOGRAFT-REJECTION, Transplantation, 64(8), 1997, pp. 1188-1192
Hemodynamics and oxygen variables, plasma cytokines, and histological
features of a liver tissue sample obtained by transvenous biopsy were
evaluated during 65 episodes of acute rejection. The hepatic venous pr
essure gradient was significantly higher in patients with acute reject
ion than in those without (5.1+/-0.3 vs. 3.1+/-0.2 mmHg, P<0.01). The
increase in pressure gradient was related to the severity of rejection
lesions. Hepatic blood flow was significantly lower in patients with
than in those without acute graft rejection (1.28+/-0.11 vs. 1.75+/-0.
13 L/min, P<0.05). Plasma interleukin-6 levels were significantly incr
eased in patients with acute rejection and positively correlated with
pressure gradient values. In patients with acute rejection, a signific
ant decrease in hepatic venous oxygen content (-16%) was associated wi
th a significant increase in hepatic oxygen consumption (+24%), wherea
s hepatic oxygen transport did not change significantly. In treated pa
tients with a favorable response, the pressure gradient decreased sign
ificantly by 46%, but it remained elevated in patients who later devel
oped chronic graft rejection. In conclusion, this study confirms that
acute graft rejection may induce an increase in portal pressure, which
is related to the severity of rejection lesions. It also shows that a
cute rejection decreases hepatic blood flow and increases hepatic oxyg
en consumption, In addition, it suggests that the hepatic venous press
ure gradient might be useful to determine the outcome of rejection.