The Circulatory System in Liver Disease

Hollenberg, Steven M.; Waldman, Brett

doi:10.1016/j.ccc.2016.02.004

Cited by 19 publications

(16 citation statements)

References 38 publications

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“…As shown within the present dataset, some degree of allograft dysfunction is common after IHR. Even moderate degrees of hepatic dysfunction can affect renal perfusion through systemically altered vascular response [26] ; decreased hepatic metabolism causes a surplus of vasodilatory nitric oxide and endothelial factors that decrease systemic vascular resistance and activate the renin-angiotensin system 27 , 28 . Exacerbating this effect is a derivative increase in splanchnic resistance.…”

Section: Discussionmentioning

confidence: 99%

Postoperative renal impairment is associated with increased length of stay for incisional hernia repair after liver transplantation

Butler

O’Brien

Kays

et al. 2019

Surgery Open Science

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Background Incisional hernia repair is the most common procedure after orthotopic liver transplantation. Although enhanced recovery protocols are increasingly employed, the post–orthotopic liver transplantation patient may not benefit from all aspects of these models. The aim of the present study is to assess which perioperative interventions and patient factors affect hospital length of stay in a cohort of post–orthotopic liver transplantation patients undergoing incisional hernia repair. Methods We conducted a retrospective review of a series of adult patients undergoing incisional hernia repair after orthotopic liver transplantation. The primary endpoint was length of stay. Results were stratified by demographic, intraoperative, and postoperative variables. Results Eleven percent (172/1523) of patients who received orthotopic liver transplantation during the study period underwent subsequent incisional hernia repair. Median length of stay was 5 days (range 2–50). The strongest predictor of length of stay was postoperative renal function. Despite liberal intraoperative administration of volume (median 642 mL/h) and brisk intraoperative urine output (median 72 mL/h), postoperative acute kidney injury occurred in 48% of patients. Those that developed acute kidney injury received less intraoperative volume (6 vs 8.5 mL/kg/h; P = .031) and the severity of postoperative renal injury was inversely related to the amount intraoperative volume given. Conclusions In patients undergoing incisional hernia repair after orthotopic liver transplantation, postoperative renal function is frequently impaired. Although many aspects of current ERAS protocols may be applied to post-transplant patients, restrictive intraoperative fluid administration strategies should be employed with caution given a high propensity for the development of post-operative acute kidney injury in this complex population.

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Section: Discussionmentioning

confidence: 99%

Postoperative renal impairment is associated with increased length of stay for incisional hernia repair after liver transplantation

Butler

O’Brien

Kays

et al. 2019

Surgery Open Science

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“…In patients with end-stage liver disease, hyperdynamic circulation is manifested in patients with end-stage liver disease as elevated cardiac output and heart rate, and reduced systemic vascular resistance with normal or decreased MAP. [ 31 ] Although overall splanchnic vascular resistance decreases, no decrease in vascular resistance is demonstrated in whole vascular beds [ 32 ] including the kidneys. [ 33 ] Renal vasoconstriction is caused by effective hypovolemia and neurohormonal activation in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Influence of oxygen content immediately after graft reperfusion on occurrence of postoperative acute kidney injury in living donor liver transplantation

Chae

Lee²,

Park³

et al. 2017

Medicine

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Acute kidney injury (AKI) is a common complication after living donor liver transplantation (LDLT). In this study, we investigated perioperative factors, including oxygen content, related to the postoperative development of AKI after LDLT. The perioperative data of 334 patients were reviewed retrospectively. We identified the postoperative development of AKI based on the Acute Kidney Injury Network criteria. Perioperative variables, including oxygen content, were compared between patients with and without AKI. Potentially significant variables in a univariate analysis were evaluated by multivariate analysis. Postoperative AKI developed in 76 patients (22.7%). Univariate analysis revealed that preoperative factors (body mass index [BMI], diabetes mellitus, C-reactive protein) and intraoperative factors (severe postreperfusion syndrome, packed red blood cell transfusion, furosemide, and oxygen content at the anhepatic phase, 5 minutes and 1 hour after graft reperfusion, and at peritoneal closure) of recipients were significant. The multivariate analysis showed that oxygen content 5 minutes after graft reperfusion, BMI, and furosemide administration were independently associated with postoperative AKI. In conclusion, postoperative AKI was independently associated with oxygen content 5 minutes after graft reperfusion, BMI, and furosemide administration. Meticulous ventilator care and transfusion should be required to maintain sufficient oxygen content immediately after graft reperfusion in patients who undergo LDLT.

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“…During the expression of the endocrine inflammatory phenotype in TPVL-rats there is a splanchnic remodeling by angiogenesis, which implies growth of new vessels from pre-existing ones[59], and fibrosis. Moreover, an abnormal splanchnic and systemic angioarchitecture, such as portosystemic collaterals have been observed in chronic liver diseases[60-62].…”

Section: The Endocrine Inflammatory Phenotypementioning

confidence: 99%

Embrionary way to create a fatty liver in portal hypertension

Aller

Arias

Peral

et al. 2017

WJGP

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Portal hypertension in the rat by triple partial portal vein ligation produces an array of splanchnic and systemic disorders, including hepatic steatosis. In the current review these alterations are considered components of a systemic inflammatory response that would develop through three overlapping phenotypes: The neurogenic, the immune and the endocrine. These three inflammatory phenotypes could resemble the functions expressed during embryonic development of mammals. In turn, the inflammatory phenotypes would be represented in the embryo by two functional axes, that is, a coelomic-amniotic axis and a trophoblastic yolk-sac or vitelline axis. In this sense, the inflammatory response developed after triple partial portal vein ligation in the rat would integrate both functional embryonic axes on the liver interstitial space of Disse. If so, this fact would favor the successive development of steatosis, steatohepatitis and fibrosis. Firstly, these recapitulated embryonic functions would produce the evolution of liver steatosis. In this way, this fat liver could represent a yolk-sac-like in portal hypertensive rats. After that, the systemic recapitulation of these embryonic functions in experimental prehepatic portal hypertension would consequently induce a gastrulation-like response in which a hepatic wound healing reaction or fibrosis occur. In conclusion, studying the mechanisms involved in embryonic development could provide key results for a better understanding of the nonalcoholic fatty liver disease etiopathogeny.

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The Circulatory System in Liver Disease

Cited by 19 publications

References 38 publications

Postoperative renal impairment is associated with increased length of stay for incisional hernia repair after liver transplantation

Postoperative renal impairment is associated with increased length of stay for incisional hernia repair after liver transplantation

Influence of oxygen content immediately after graft reperfusion on occurrence of postoperative acute kidney injury in living donor liver transplantation

Embrionary way to create a fatty liver in portal hypertension

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