Cirrhosis is known to induce capillarization of the sinusoidal endothelial cells (SECs) and collagenization of the space of Disse, resulting in a reduced access of plasma and plasma-dissolved substances to hepatocytes due to their limited diffusion in the extravascular space. The aim of the present study was to use a well known effect of cold ischemia-warm reperfusion (CI-WR) on liver SECs, that is, their retraction and detachment, progressing to a denudation of the SEC lining. The disappearance of the capillarized SEC lining would improve the access of plasma and plasma-dissolved substances to the hepatocytes and consequently might improve the metabolic function of cirrhotic livers. This study was performed using the isolated perfused rat liver model subjected to 24-hour CI followed by a 60-minute WR in thioacetamide-induced cirrhosis. Liver microcirculation was evaluated using the multiple indicator dilution curve (MIDC) technique. Hepatocyte, SEC, and Kupffer cell functions were evaluated using specific elimination processes. As occurs in normal livers, CI-WR induced extensive SEC necrosis with a marked reduction of the hyaluronic acid elimination. By contrast, the hepatic microcirculation was not modified: vascular, extravascular, and the cellular spaces were similar before and following CI-WR. In addition, the hepatic metabolic functions, as evaluated by propranolol and taurocholate hepatic uptake, were neither improved nor decreased, as were Kupffer cell functions. The present data strongly suggest that capillarization of SECs plays a lesser role than collagenization of the space of Disse in the reduced exchange between sinusoids and hepatocytes in thioacetamide-induced cirrhotic rat livers, which appear to be quite resistant to CI-WR. Liver Transpl 14:486-493, 2008. © 2008 AASLD.
Received July 14, 2007; accepted October 11, 2007.Within the normal hepatic acinus, sinusoids have a unique structure to the liver that allows maximum contact between the hepatocytes and blood perfusing the liver. The endothelial cells lining the sinusoids, the sinusoidal endothelial cells (SECs), are perforated by a multitude of fenestrae 50 to 200 nm in diameter, but there is no continuous basement membrane.1 A large extravascular space (the space of Disse) lies behind the endothelial lining and is continuous with the extracellular space up to the tight junction of hepatocytes, which separate the extravascular space from bile canaliculi. Under normal conditions, a few collagen bundles can be found within the space of Disse. The entire space is therefore freely accessible to all large molecules contained in plasma, but red blood cells (RBC) larger than the fenestrae do not have access to the space of Disse. This arrangement is unique, since in no other organ do substances carried in the plasma have such direct access to the membrane where the uptake process occurs.In the presence of chronic liver diseases, 3 types of alterations of the liver microcirculation have been reported: (1) Capillarization of the sinusoids with disappear...