Intraoperative direct measurement of hepatic arterial buffer response in patients with or without cirrhosis

The hepatic arterial buffer response (HABR) is an intrinsic regulatory mechanism of the hepatic artery (HA) that compensates for reductions in portal venous (PV) blood flow. Whether this response is maintained in patients with cirrhosis (LC) is unclear. The aim of the present study was to examine whether HABR is maintained in patients with LC using direct blood flow measurements. PV and HA blood flow were intraoperatively measured and compared in patients with (LC group, n = 39) or without (control group, n = 22) cirrhosis at baseline (baseline HABR) and after PV clamping (acute HABR) using an ultrasound transit‐time flowmeter. In contrast to the proportional relationship between the baseline PV and HA blood flow observed in the control group, HA blood flow and the HA‐PV flow ratio increased when PV blood flow decreased in the LC group, suggesting that the baseline HABR had already been activated. Acute HABR, evaluated by the absolute and relative changes in HA blood flow and by the buffer capacity, was blunted in the LC group (P < 0.001, P < 0.01, and P = 0.01, respectively). An association between the degree of acute HABR impairment and the level of baseline HABR activation (HA‐PV flow ratio) could not be confirmed in the LC group. In conclusion, the baseline HABR appears to be continuously activated in patients with LC; this phenomenon probably results in the impairment of the acute HABR. (Liver Transpl 2005;11:684–691.)

[1]  Jukka Takala,et al.  Splanchnic Vasoregulation During Mesenteric Ischemia and Reperfusion in Pigs , 2002, Shock.

[2]  Klaus Haag,et al.  Hepatic arterial buffer response in patients with advanced cirrhosis , 2002, Hepatology.

[3]  A. Moreno,et al.  Hepatic Artery Flow Improvement After Portacaval Shunt: A Single Hemodynamic Clinical Correlate , 1976, Annals of surgery.

[4]  E. Mattsson,et al.  Volume blood flow measurements with a transit time flowmeter: an in vivo and in vitro variability and validation study. , 1993, Clinical physiology.

[5]  S. Sumi,et al.  Simultaneous measurement of hepatic arterial and portal venous flows by transit time ultrasonic volume flowmetry. , 1988, Surgery, gynecology & obstetrics.

[6]  M. Lafortune,et al.  Hepatic artery: effect of a meal in healthy persons and transplant recipients. , 1993, Radiology.

[7]  W. Lautt.  Hepatic circulation in health and disease , 1981 .

[8]  S. Hanna,et al.  Effect of portal vein occlusion on liver blood flow in normal and cirrhotic dogs. , 1986, The Journal of surgical research.

[9]  W W Lautt,et al.  Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. , 1985, The American journal of physiology.

[10]  W W Lautt,et al.  Relationship between hepatic blood flow and overall metabolism: the hepatic arterial buffer response. , 1983, Federation proceedings.

[11]  C. Vigouroux,et al.  Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition. , 1990, Surgery.

[12]  J. Ellis,et al.  Hepatic artery resistance before and after standard meal in subjects with diseased and healthy livers. , 1995, Radiology.

[13]  W. Fleig,et al.  Hepatic arterial flow volume and reserve in patients with cirrhosis: use of intra-arterial Doppler and adenosine infusion. , 1999, Gastroenterology.

[14]  ndrea,et al.  Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. , 1996, The New England journal of medicine.

[15]  R. Pugh,et al.  Transection of the oesophagus for bleeding oesophageal varices , 1973, The British journal of surgery.

[16]  W G SCHENK,et al.  Direct Measurement of Hepatic Blood Flow in Surgical Patients: With Related Observations on Hepatic Flow Dynamics in Experimental Animals , 1962, Annals of surgery.

[17]  M. Kutner,et al.  Hemodynamics during liver transplantation: The interactions between cardiac output and portal venous and hepatic arterial flows , 1992, Hepatology.

[18]  A. Toyonaga,et al.  Hepatic artery hemodynamic responsiveness to altered portal blood flow in normal and cirrhotic livers. , 1996, Radiology.

[19]  P. Angeli,et al.  Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationships with portal hemodynamics. , 1995, Gastroenterology.

[20]  Angelo Gatta,et al.  Change in portal flow after liver transplantation: Effect on hepatic arterial resistance indices and role of spleen size , 2002, Hepatology.

[21]  D. Verran,et al.  Hepatic artery thrombosis and intraoperative hepatic artery flow rates in adult orthotopic liver transplantation , 2002, ANZ journal of surgery.

[22]  F. Jakab,et al.  The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry. , 1995, Hepato-gastroenterology.

[23]  Robert T. Mathie,et al.  The hepatic arterial blood flow response to portal vein occlusion in the dog , 1980, Pflügers Archiv.

[24]  W. Castañeda-Zúñiga,et al.  Duplex sonography after transjugular intrahepatic portosystemic shunts (TIPS): normal hemodynamic findings and efficacy in predicting shunt patency and stenosis. , 1995, AJR. American journal of roentgenology.

[25]  M. Menger,et al.  Impact of intrinsic blood flow regulation in cirrhosis: maintenance of hepatic arterial buffer response. , 2000, American journal of physiology. Gastrointestinal and liver physiology.

[26]  L. Smith,et al.  Liver Circulation and Function during Isoflurane and Halothane Anesthesia , 1984, Anesthesiology.

[27]  M. Bellamy,et al.  Effects of desflurane and isoflurane on splanchnic microcirculation during major surgery. , 1997, British journal of anaesthesia.