Anesth Pain Med.  2016 Apr;11(2):117-129. 10.17085/apm.2016.11.2.117.

Effects of portal hyperperfusion on partial liver grafts in the presence of hyperdynamic splanchnic circulation: hepatic regeneration versus portal hyperperfusion injury

• Kim JH

• KMID: 2358474
• DOI: http://doi.org/10.17085/apm.2016.11.2.117

Abstract

In cirrhotic patients undergoing liver transplantation, reperfusion of a liver graft typically increases portal venous blood flow (PVF) because of a decrease in resistance in the liver graft to the PVF and underlying hyperdynamic splanchnic circulation, which develops due to liver cirrhosis complicated by portal hypertension and persists even after successful liver transplantation. If the liver graft has enough capacity to accommodate the increased PVF, the shear stress inflicted on the sinusoidal endothelial cells of the graft promotes hepatic regeneration; otherwise, small-for-size syndrome (SFSS) develops, leading to poor graft function and graft failure. In particular, a partial graft transplanted to patients undergoing living donor liver transplantation has less capacity to accommodate the enhanced PVF than a whole liver graft. Thus, the clinical conditions that the partial graft encounters determine either hepatic regeneration or development of SFSS. Consistent with this, this review will discuss the two conflicting effects of portal hyperperfusion (hepatic regeneration vs. portal hyperperfusion injury) on the partial grafts in cirrhotic patients suffering from hyperdynamic splanchnic circulation, in addition to normal physiology and pathophysiology of hepatic hemodynamics.

Keyword

Liver cirrhosis; Liver regeneration; Liver transplantation; Portal hypertension; Splanchnic circulation

MeSH Terms

Endothelial Cells
Hemodynamics
Humans
Hypertension, Portal
Liver Cirrhosis
Liver Regeneration
Liver Transplantation
Liver*
Living Donors
Physiology
Regeneration*
Reperfusion
Splanchnic Circulation*
Transplants*

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