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The hepatic microcirculation in the isolated perfused human liver
J P Villeneuve1, M Dagenais, P M Huet
1Department of Medicine, Centre de recherche clinique André-Viallet, Hôpital Saint-Luc, Montreal, Quebec, Canada.
Hepatology (Baltimore, Md.)
|January 1, 1996
Summary
Cirrhosis impairs liver function by altering sinusoidal permeability and creating intrahepatic shunts. These microcirculatory changes, including capillarization, hinder nutrient exchange and contribute to liver failure.
Area of Science:
- Hepatology
- Microcirculation Research
- Transplantation Science
Background:
- Cirrhosis leads to sinusoidal capillarization, potentially causing liver failure independent of metabolic capacity.
- Understanding hepatic microcirculation anomalies is crucial for assessing liver function in cirrhosis.
Purpose of the Study:
- To characterize microcirculatory anomalies in human cirrhotic livers using the multiple-indicator dilution technique.
- To compare hepatic microcirculation in cirrhotic livers with normal and steatotic livers from organ donors.
Main Methods:
- Multiple-indicator dilution technique applied to isolated perfused human livers (cirrhotic and donor).
- Assessment of sinusoidal volume, permeability (albumin, sucrose, water), and extravascular volume (EVV).
- Analysis of intrahepatic shunts and correlation with indocyanine green (ICG) extraction.
Main Results:
- Normal livers showed comparable sinusoidal parameters to animal models; EVV varied with injection route.
- Cirrhotic livers exhibited capillarization and intrahepatic shunts (21% +/- 16% portal flow).
- Decreased albumin-accessible EVV and barrier-limited sucrose diffusion in cirrhosis correlated with impaired ICG elimination.
Conclusions:
- Diffusible tracer behavior in normal human livers aligns with animal studies.
- Cirrhotic livers display abnormal sinusoidal permeability and intrahepatic shunts.
- Altered permeability in cirrhosis is directly related to diminished liver function.