Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion

Dinant, Sander; Veen, Suzanne Q. van; Roseboom, Hendrik J.; Vliet, Arlène K. van; Gulik, Thomas M. van

doi:10.1111/j.1478-3231.2006.01248.x

Cited by 20 publications

(13 citation statements)

References 26 publications

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“…It was further shown that the protective effects of hypothermia were optimal when ischemic livers were cooled to 26°C, whereas lower temperatures did not impart additional hepatoprotection (29). This finding is in line with other reports (30) and suggests that a relatively modest decrease in liver temperature during ischemia is sufficient to reduce I/R injury. It is important to underscore, the same metabolic responses to ischemia, including succinate buildup, were more pronounced in ischemic livers than in other ischemic organs (heart, kidney) (11).…”

Section: Mitochondrial Metabolismsupporting

confidence: 81%

“…At 24 h of reperfusion, improved hepatic microcirculatory perfusion, less endothelial injury and reduced lipid peroxidation were seen after IHP compared to THVE alone (76). In a similar study using 60 min of THVE, survival in the IHP groups (28°C or 20°C liver temperature) was 100% compared with 66% in normothermic THVE controls (30). Moreover, the use of IHP preserved bile production and reduced AST and IL-6 levels.…”

Section: Hepatocyte Transportersmentioning

confidence: 59%

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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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Section: Mitochondrial Metabolismsupporting

confidence: 81%

Section: Hepatocyte Transportersmentioning

confidence: 59%

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Olthof

Reiniers

Dirkes

et al. 2015

Mol Med

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“…As a result of that, energy supplies are preserved, the amount of oxidative stress is reduced, and the detrimental late inflammatory response characteristic of I/R injury is hampered [40,41] . Overall, these effects result in better postoperative recovery, as has been shown by a series of experimental studies conducted in our surgical laboratory [42][43][44][45] .…”

Section: Thve (Combined With Cold Perfusion)mentioning

confidence: 65%

Vascular Occlusion or Not during Liver Resection: The Continuing Story

et al. 2012

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Background: Vascular occlusion can be applied during liver resection to reduce blood loss. Herein, we provide an update of the current evidence concerning vascular occlusion. Methods: A systematic literature search was conducted to review the effects of liver in- and outflow occlusion techniques during liver resection, focusing on blood loss and hepatic ischemia-reperfusion injury. Results: The Pringle maneuver (PM) is effective in controlling blood loss; however, there is no indication for routine vascular clamping during hepatic resection in uncomplicated patients. During complex resections and in patients with abnormal liver parenchyma, the intermittent PM is preferred over continuous clamping. Total hepatic vascular exclusion (THVE) is indicated only in resection of tumors involving the inferior caval vein or the caval hepatic junction. THVE can be applied with the preservation of caval vein flow. This mode of selective hepatic vascular exclusion results in less blood loss in combination with the PM. Conclusion: If clamping is necessary during complex resections or in abnormal liver parenchyma, intermittent PM is advised. THVE or selective hepatic vascular exclusion may be considered in tumors involving the inferior caval vein or the caval hepatic junction. There is no evidence supporting the use of ischemic preconditioning, maintenance of a low central venous pressure or of pharmacological interventions during liver resection.

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“…Although the human liver might tolerate ischemia better than excessive blood loss, the adverse effects of ischemia should not be disregarded. The damage incurred by post-ischemic reperfusion to the liver parenchymal cells and the microvascular system are well established, both in experimental studies as well as in clinical studies [26, 49, 59, 60]. Especially in livers with pre-existent disease such as cirrhosis or steatosis, the injurious effects of ischemia/reperfusion injury have shown to be enhanced [61].…”

Section: Discussionmentioning

confidence: 99%

Vascular Occlusion Techniques during Liver Resection

Gulik

Graaf²,

Dinant³

et al. 2007

Dig Surg

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Control of bleeding from the transected liver basically consists of vascular inflow occlusion and control of hepatic venous backflow from the caval vein. Central venous pressure determines the pressure in the hepatic veins and is an extremely important factor in controlling blood loss through venous backflow. Vascular inflow occlusion (Pringle maneuver) involves clamping of the portal vein and the hepatic artery in the hepatic pedicle and gives rise to postischemic, reperfusion injury. Several strategies have been devised to reduce reperfusion injury (pharmacological interventions) or to increase ischemic tolerance of the liver (ischemic preconditioning). Intermittent clamping is recommended in complex liver resections or in patients with diseased livers. The combination of occlusion of vascular inflow and outflow of the liver results in total hepatic vascular exclusion (THVE) and is mainly used in tumors invading the caval vein. During THVE the liver can be cooled by hypothermic perfusion allowing for extended ischemia times. Selective THVE entails clamping of the main hepatic veins in their extrahepatic course, thus preserving caval flow. Safe liver surgery requires knowledge of the regular techniques of vascular occlusion for ‘on demand’ use when necessitated to reduce blood loss.

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Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion

Abstract: HP at 20 degrees C is equally effective in preserving liver function and preventing hepatocellular injury under TVE as compared with HP at 28 degrees C. HP at 28 degrees C is advised, because of the lesser perfusion volume necessary for cooling of the liver.

Cited by 20 publications

References 26 publications

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Vascular Occlusion or Not during Liver Resection: The Continuing Story

Vascular Occlusion Techniques during Liver Resection

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