Abstract
To date, no method is available for the continuous longterm monitoring of liver microcirculation in patients. Experimentally, thermodiffusion has been validated in the quantification of hepatic perfusion. In an attempt to investigate the practicability of thermodiffusion technology in patients after liver transplantation thermodiffusion probes were inserted into the graft in seven patients during liver transplantation. Continous monitoring started intraoperatively and was performed until day 7, when the probes were extracted transcutaneously. No probe-related complications (i. e., hemorrhage, infection) were observed. In four patients with normal graft function, liver perfusion recovered within 12 h from the intraoperative reduction to a range between 85 and 93 ml/100 g per min. In contrast, primary graft failure (n = 1) was characterized by a constant decrease of hepatic perfusion (< 50 m1/100 g per min). In prolonged reperfusion injury (n = 1), a second peak of transaminases was paralled by an impairment of liver microcirculation. In one patient, R2 rejection on day 7 was preceded by a drop in hepatic perfusion 48 h earlier. Thus, thermodiffusion is a safe and reliable method for the continuous quantification of liver microcirculation after transplantation in patients. Measurements are reproducible for at least 7 days. Changes in hepatic perfusion during postoperative complications can be detected. The characteristics of microcirculatory disorders will have to be defined in a larger number of patients.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Kim YI, Kai T, Kawano T, et al (1992) 7. Predictive value of liver tissue flow in assessment of the viability of liver grafts after extended preservation in pigs. Transplant Int 5 (Suppl 1 ): S382 — S387
Klar E, Kraus T, Bleyl J, et al (1995) Thermodiffusion as a novel method for continuous monitoring of hepatic mi- 8. crocirculation after liver transplanta-tion. Transplant Proc 27: 2610–2612
Manner M, Schult W, Senninger N et al (1990) Evaluation of preservation dam- age after porcine liver transplantation 9. by assessment of hepatic microcirculation. Transplantation 50: 940–943
Mathie RT, Nagorney DM, Blumgart LH (1989) Liver blood flow: physiology, measurement and clinical relevance. 10. Anat Pathophysiol 98: 73–87
Yamamoto K, Sherman I, Phillips MJ, Fisher MM (1985) Three-dimensional observations of the hepatic arterial terminations in rat, hamster and human li- 11. ver by scanning electron microscopy of microvascular casts. Hepatology 5: 452–456
Hoefs JC, Reynolds TB, Pare P, Saki- 12. mura I (1984) A new method for the measurement of intrahepatic shunts. J Lab Clin Med 103: 446–461
Manner M, Senninger N, Thies J, et al (1991) Intrahepatic shunt predicts graft function after liver transplantation in pigs. In: Engemann R, Hamelman H (eds) Experimental and clinical liver transplantation. Elsevier Science Publishers, Amsterdam, pp 83–86
Hermann A, Hoffmann V, Richter GM, et al (1 995) The leafless tree sign: a specific angiographic finding after liver transplantation suggesting acute liver necrosis. Eur Radiol 5: S242–243
Caldwell-Kenkel JC, Currin RT, Tanaka Y, et al (1989) Reperfusion injury to endothelial cells following cold ischemic storage of rat livers. Hepatology 10: 292–299
Lim PS, Andrews FJ, Christophi C, O’Brien PE (1994) Microvascular changes in liver after ischemia-reperfusion injury. Protection with misoprostol. Dig Dis Sci 39: 1683–1690
Thurmann Rg, Marzi I, Seitz G, et al (1988) Hepatic reperfusion injury following orthotopic liver transplantation in the rat. Transplantation 46: 502–506
Jaeschke H, Farhood A (1991) Neutro-phil and Kupffer cell induced oxidant stress and ischemia-reperfusion injury in rat liver. Am J Physiol 260: G355 — G362
Marzi I, Takei Y, Knee J, et al (1990) Assessment of reperfusion injury by intravital fluorescence microscopy following liver transplantation in the rat. Transplant Proc 22: 2004–2005
Post S, Palma P, Rentsch M, et al (1993) Differential impact of Carolina rinse and University of Wisconsin solutions on microcirculation, leukocyte adhesion, Kupffer cell activity and biliary excretion after liver transplantation. Hepatology 18: 1490–1497
Wheatley AM, Zhao D (1993) Intraoperative assessment by laser doppler flowmetry of hepatic perfusion during orthotopic liver transplantation in the rat. Transplantation 56: 1315–1318
Leibermann DP, Mathie RT, Harper AM, Blumgart LH (1978) The hepatic arterial and portal venous circulations of the liver studied with a krypton-85 clearance technique. J Surg Res 25: 154–162
Altmayer P, Grundmann U, Ziehmer M, et al (1991) Cardiac output and liver blood flow in humans: effect of the volatile anesthetic halothane. Methods Find Exp Clin Pharmacol 13: 709–714
Sheperd AP, Riedel GL, Kiel JW, et al (1987) Evaluation of an infrared laser-Doppler blood flowmeter. Am J Physiol 252: G832 — G839
Zurbrügg HR, De P, Bachmann S, et al (1994) Continous blood flow measurements after liver transplantation: first clinical experience. Transplant Proc 26: 2218–2226
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1996 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Klar, E. et al. (1996). First clinical realization of continuous monitoring of liver microcirculation after transplantation by thermodiffusion. In: Mühlbacher, F., et al. Transplant International . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-00818-8_35
Download citation
DOI: https://doi.org/10.1007/978-3-662-00818-8_35
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-61024-3
Online ISBN: 978-3-662-00818-8
eBook Packages: Springer Book Archive