In Situ Hypothermic Perfusion of the Liver Versus Standard Total Vascular Exclusion for Complex Liver Resection

Azoulay, Daniel; Eshkenazy, Rony; Andreani, P.; Castaing, Denis; Adam, René; Ichaı̈, Philippe; Naili, Salima; Vinet, E; Saliba, Faouzi; Lemoine, Antoinette; Gillon, Marie-Christine; Bismuth, H

doi:10.1097/01.sla.0000152017.62778.2f

Cited by 171 publications

(136 citation statements)

References 40 publications

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“…The advantage of HP during TVE was confirmed in this study and is in agreement with other reports [7][8][9][10][11][12]. Although no differences in parenchymal damage and microcirculatory perfusion were found, HP with Celsior solution resulted in less decrease of arterial pH and base loss, better restoration of bile production, more radical scavenging capacity, and better maintenance of coagulation capacity as compared to HP with Ringer-lactate solution.…”

Section: Discussionsupporting

confidence: 82%

“…At 28°C, however, cellular metabolism and oxygen demand is still around 50% [13]. Next to RL solution, organ preservation solutions have also been applied during HP [8,9]. The advantage of organ preservation solutions lies in their ability to prevent tissue acidosis, cell swelling, free radical damage, and energy depletion, all phenomena which occur during ischemia and subsequent reperfusion.…”

Section: Introductionmentioning

confidence: 99%

“…In situ hypothermic perfusion (HP) of the liver during TVE is an option to reduce hepatic I-R injury during extensive liver resections [7][8][9][10][11][12]. The protective effect of HP is based on the concept that hypothermia leads to diminished metabolism and, hence, decreased energy and oxygen demand.…”

Section: Introductionmentioning

confidence: 99%

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Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Dinant

Roseboom

Levi

et al. 2008

Langenbecks Arch Surg

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Background Hypothermic perfusion (HP) of the liver is applied during total vascular exclusion (TVE) to reduce ischemic injury during liver resection. No studies have been performed comparing different perfusion solutions for HP. The aim of this experimental study was to compare Ringerlactate solution (RL) with Celsior solution (Cs) for HP in a pig model of 60-min TVE. Method Twenty pigs underwent 60-min TVE of the liver. Groups were TVE without HP (no-HP, n=9), TVE with HP using RL (n=6), and TVE with HP using Cs (n=5). Blood and liver tissue samples were taken before TVE and during 24-h reperfusion. Results In the no-HP group, plasma aspartate aminotransferase values were significantly increased during reperfusion (p<0.05), while liver tissue pO 2 levels (p< 0.01) were decreased when compared to the HP groups. After 24-h reperfusion, bile production and liver tissue glutathione content were significantly higher (p<0.05) in the Cs group (42.0±1.7 mL/h and 44.9±2.2 nmol/mg, respectively) as compared to the RL group (31.5±3.5 mL/h and 19.6±1.8 nmol/mg, respectively). ConclusionThe protective effect of HP during TVE was confirmed in this study. HP with Cs was more effective in reducing ischemic injury as compared to HP with RL.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Dinant

Roseboom

Levi

et al. 2008

Langenbecks Arch Surg

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“…VIO durations up to 2 h were well tolerated using this technique, enabling the removal of tumors that were otherwise considered not resectable, albeit at the expense of a considerable (10.3%) mortality rate. Consequently, only a small number of technical feasibility studies on IHP in stringently selected cases were published in the following years (7,72,73).…”

Section: Clinical Status Quo Of Organ Cooling In Liver Surgery Liver mentioning

confidence: 99%

“…The first large hypothermia study comprised 20 cases of IHP during THVE that were compared to two THVE control groups (73). IHP was performed when the anticipated duration of THVE was deemed to be >60 min.…”

Section: Hepatocyte Transportersmentioning

confidence: 99%

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Olthof

Reiniers

Dirkes

et al. 2015

Mol Med

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Hepatic ischemia/reperfusion (I/R) injury is a side effect of major liver surgery that often cannot be avoided. Prolonged periods of ischemia put a metabolic strain on hepatocytes and limit the tolerable ischemia and preservation times during liver resection and transplantation, respectively. In both surgical settings, temporarily lowering the metabolic demand of the organ by reducing organ temperature effectively counteracts the negative consequences of an ischemic insult. Despite its routine use, the application of liver cooling is predicated on an incomplete understanding of the underlying protective mechanisms, which has limited a uniform and widespread implementation of liver-cooling techniques. This review therefore addresses how hypothermia-induced hypometabolism modulates hepatocyte metabolism during ischemia and thereby reduces hepatic I/R injury. The mechanisms underlying hypothermia-mediated reduction in energy expenditure during ischemia and the attenuation of mitochondrial production of reactive oxygen species during early reperfusion are described. It is further addressed how hypothermia suppresses the sterile hepatic I/R immune response and preserves the metabolic functionality of hepatocytes. Lastly, a summary of the clinical status quo of the use of liver cooling for liver resection and transplantation is provided.

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Methods of vascular occlusion for elective liver resections

Gurusamy

Kumar

Sharma

et al. 2007

Cochrane Database of Systematic Reviews

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Intermittent vascular occlusion seems safe in liver resection. However, it does not seem to decrease morbidity. Among the different methods of vascular occlusion, intermittent portal triad clamping has most evidence to support the clinical application. Hepatic vascular exclusion cannot be recommended routinely. Ischaemic preconditioning before continuous portal triad clamping may be of clinical benefit in reducing intensive therapy unit and hospital stay.

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In Situ Hypothermic Perfusion of the Liver Versus Standard Total Vascular Exclusion for Complex Liver Resection

Cited by 171 publications

References 40 publications

Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Methods of vascular occlusion for elective liver resections

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