Effects of partial hepatic venous congestion on hepatic hemodynamics and histology

Extensive liver resection potentially causes hepatic venous congestion resulting in critical liver damage. The effects of partial hepatic venous congestion on hepatic hemodynamics and histology were studied.

Male Wistar rats underwent hepatic vein ligation of left lateral lobe (35%) or left lateral and median lobes (70%). Systemic and hepatic hemodynamics was measured following hepatic vein ligation of 35% lobe.

Rats with 35% hepatic venous congestion survived while rats with 70% hepatic venous congestion died within 2 days after surgery. Blood pressure of carotid artery and central vein, and blood flow of hepatic artery and portal vein transiently decreased after surgery (p < 0.05), while portal venous pressure increased significantly after surgery (p < 0.05). Partial hepatic venous congestion blocked portal flow to the congested lobe, and blood flow of the congested lobe was maintained only by hepatic arterial flow. Partial hepatic venous congestion caused massive necrosis of hepatocytes in the central vein lobules and intermediate area, while hepatocytes in the periportal area were being preserved.

These results suggest that in patients undergoing extensive liver resection or LDLT, preservation of hepatic arterial flow or hepatic vein reconstruction of the congested area should be recommended depending on congested liver volume.