Combined evaluation of total and functional liver plasma flows and intrahepatic shunting

Abstract

A diagnostic protocol was studied, designed to evaluate the main parameters of liver circulation in man. A water solution of D-sorbitol (S) and indocyanine green (ICG) was infused intravenously in six controls and nine cirrhotics. Steady-state renal and hepatic S clearances as well as hepatic ICG clearance were calculated. In controls the values (mean +/- SD) of the independent measurements of S and ICG hepatic clearance were 978 +/- 107 and 519 +/- 142 ml/min, respectively, while in cirrhotic patients they were 554 +/- 238 and 231 +/- 90 ml/min. Owing to the kinetic properties of S, its hepatic clearance may be regarded as a measure of functional liver plasma flow (FLPF). The total liver plasma flow (TLPF) values (mean +/- SD), calculated according to Fick's principle, were 1091 +/- 157 ml/min (S method) and 1033 +/- 153 ml/min (ICG method) in controls, and 1251 +/- 554 and 1284 +/- 677 ml/min in cirrhotics. In controls, FLPF was found to be very close to TLPF. In cirrhotic patients the difference between TLPF and FLPF (ranging from 169 to 2093 ml/min when measured by S method) was considered as an approximate estimate of intrahepatic shunting. The procedure is safe and simple and may add a new dimension to the investigation of hepatic circulation.

Hepatic Blood Flow and Splanchnic Oxygen Consumption in Patients With Liver Failure. Effect of High–Volume Plasmapheresis

“…2 In patients without evidence of liver disease and in patients with cirrhosis, hepatic plasma flow estimated by use of both ICG and D-sorbitol agreed well. [20][21][22] Moreover, in six patients with liver failure where HBF could be estimated by both methods, HBF also agreed well. 2 The use of two different compounds is therefore considered not to introduce any significant bias in our result.…”

Functional hepatic flow in patients with liver cirrhosis

“…Generally THF was measured by means of the hepatic extraction of D-sorbitol and indocyanine green, according to the Fick's principle [4,10] . But the procedure, which needs hepatic vein catheterization is invasive and difficult to popularize.…”

“…However, such an approach can not directly provide reliable quantitative evaluations of the integrity and functional reserve of the hepatic parenchyma because the parameters are not very specific and test sensitivity is sometimes too low to detect mild liver alteration [2] . Recently several studies [3][4][5][6][7][8][9][10] have considered that hepatic clearance of D-sorbitol was a valid procedure in determination of FHF, by which hepatic reserve function could be estimated. The aim of this study was to measure THF and FHF of control subjects and patients with cirrhosis by means of duplex doppler color sonography combined with modified hepatic clearance of D-sorbitol and then to evaluate the hepatic reserve function.…”

Sorbitol as a test substance for measurement of liver plasma flow in humans

“…1 The ''gold standard'' method to measure the liver plasma flow rate involves constant infusion of indocyanine green (ICG), which is eliminated only in the bile, 2 with ICG concentration measurements in plasma samples from a peripheral artery and a hepatic vein, and calculation according to Fick' s mass conservation principle. 3 Molino et al [4][5][6] and others 7 proposed the use of sorbitol as a test substance for estimation of liver plasma flow by a clearance method to avoid liver vein catheterization. In individuals with no liver disease, a hepatic sorbitol extraction fraction of 0.90 or higher 5,7 and negligible extrahepatic, extrarenal removal supported the use of extrarenal sorbitol clearance as a measure of liver plasma flow in these individuals.…”

“…Accordingly, sorbitol clearance (corrected for renal excretion) was proposed as a measure of a ''functional hepatic plasma flow rate.'' 6,[8][9][10] However, because it is not possible by concentration measurements in a liver vein to distinguish between the effects of reduced liver cell sorbitol removal and the effects of intrahepatic vascular shunts draining into the liver veins, this use of sorbitol clearance is controversial. 11 The purpose of the present study was: 1) to evaluate wholebody sorbitol removal kinetics; 2) to quantify the assumptions of the use of low-dose sorbitol infusion sorbitol clearance (corrected for renal excretion) as a measurement of liver plasma flow in individuals with no liver disease and in patients with cirrhosis.…”