Effects of portal hyperperfusion on partial liver grafts in the presence of hyperdynamic splanchnic circulation: hepatic regeneration versus portal hyperperfusion injury
Anesthesia and Pain Medicine
;
: 117-129, 2016.
Article
in English
| WPRIM
| ID: wpr-215143
ABSTRACT
In cirrhotic patients undergoing liver transplantation, reperfusion of a liver graft typically increases portal venous blood flow (PVF) because of a decrease in resistance in the liver graft to the PVF and underlying hyperdynamic splanchnic circulation, which develops due to liver cirrhosis complicated by portal hypertension and persists even after successful liver transplantation. If the liver graft has enough capacity to accommodate the increased PVF, the shear stress inflicted on the sinusoidal endothelial cells of the graft promotes hepatic regeneration; otherwise, small-for-size syndrome (SFSS) develops, leading to poor graft function and graft failure. In particular, a partial graft transplanted to patients undergoing living donor liver transplantation has less capacity to accommodate the enhanced PVF than a whole liver graft. Thus, the clinical conditions that the partial graft encounters determine either hepatic regeneration or development of SFSS. Consistent with this, this review will discuss the two conflicting effects of portal hyperperfusion (hepatic regeneration vs. portal hyperperfusion injury) on the partial grafts in cirrhotic patients suffering from hyperdynamic splanchnic circulation, in addition to normal physiology and pathophysiology of hepatic hemodynamics.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Physiology
/
Regeneration
/
Splanchnic Circulation
/
Reperfusion
/
Liver Transplantation
/
Living Donors
/
Transplants
/
Endothelial Cells
/
Hemodynamics
/
Hypertension, Portal
Limits:
Humans
Language:
English
Journal:
Anesthesia and Pain Medicine
Year:
2016
Type:
Article
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