R. Hickman et al., HEPATIC BLOOD-FLOW DURING REDUCED LIVER GRAFTING IN PIGS - A COMPARISON OF CONTROLS AND RECIPIENTS OF INTACT ALLOGRAFTS, Digestive diseases and sciences, 40(6), 1995, pp. 1246-1251
Intraoperative changes in portal venous and hepatic arterial flow were
compared in porcine recipients of reduced liver grafts with recipient
s of intact grafts and sham-operated controls, Control animals showed
no significant changes in hepatic blood flow (measured with perivascul
ar ultrasonic cuffs), heart rate, mean arterial pressure, cardiac outp
ut, acid/base balance, plasma sodium, potassium, glucose, or catechola
mines. Recipients of intact or reduced grafts showed hypotension, redu
ced cardiac output, tachycardia, and increased systemic vascular resis
tance during the anhepatic phase, which lasted approximately 30 min. T
hese changes returned to normal in recipients of intact grafts but in
recipients of reduced grafts, levels returned only to 50-60% of baseli
ne, After intact grafting, total liver blood flow and the portal and a
rterial components returned to baseline within 2 hr of revascularizati
on, but after reduced grafting, hepatic arterial flow values remained
depressed to 50-60% of baseline. Plasma epinephrine and norepinephrine
were unaltered during control operation but increased 4- to 20-fold i
n recipients of all grafts, These returned towards baseline in all exc
ept recipients of reduced grafts, in which norepinephrine levels remai
ned significantly elevated for the 4 hr of postoperative study, These
data highlight persistent elevation of plasma norepinephrine after red
uced liver grafting, which may have contributed to the diminished hepa
tic arterial flow. These results need to be confirmed in adult recipie
nts of split liver grafts in whom grafts are comparatively small, In s
uch patients receiving donor livers which have undergone prolonged sto
rage, the effects of increased plasma norepinephrine levels upon donor
agonal arterial spasm may be significant.