Hepatic Artery Group Research Articles

Hydrogen Flush After Cold Storage as a New End-Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury.

Cold storage (CS) remains the gold standard for organ preservation worldwide, although it is inevitably associated with ischemia/reperfusion injury (IRI). Molecular hydrogen (H2) is well known to have antioxidative properties. However, its unfavorable features, ie, inflammability, low solubility, and high tissue/substance permeability, have hampered its clinical application. To overcome such obstacles, we developed a novel reconditioning method for donor organs named hydrogen flush after cold storage (HyFACS), which is just an end‐ischemic H2 flush directly to donor organs ex vivo, and, herein, we report its therapeutic impact against hepatic IRI. Whole liver grafts were retrieved from Wistar rats. After 24‐hour CS in UW solution, livers were cold‐flushed with H2 solution (1.0 ppm) via the portal vein (PV), the hepatic artery (HA), or both (PV + HA). Functional integrity and morphological damages were then evaluated by 2‐hour oxygenated reperfusion at 37°C. HyFACS significantly lowered portal venous pressure, transaminase, and high mobility group box protein 1 release compared with vehicle‐treated controls (P < 0.01). Hyaluronic acid clearance was significantly higher in the HyFACS‐PV and ‐PV + HA groups when compared with the others (P < 0.01), demonstrating the efficacy of the PV route to maintain the sinusoidal endothelia. In contrast, bile production and lactate dehydrogenase leakage therein were both significantly improved in HyFACS‐HA and ‐PV + HA (P < 0.01), representing the superiority of the arterial route to attenuate biliary damage. Electron microscopy consistently revealed that sinusoidal ultrastructures were well maintained by portal HyFACS, while microvilli in bile canaliculi were well preserved by arterial flush. As an underlying mechanism, HyFACS significantly lowered oxidative damages, thus improving the glutathione/glutathione disulfide ratio in liver tissue. In conclusion, HyFACS significantly protected liver grafts from IRI by ameliorating oxidative damage upon reperfusion in the characteristic manner with its route of administration. Given its safety, simplicity, and cost‐effectiveness, end‐ischemic HyFACS may be a novel pretransplant conditioning for cold‐stored donor organs.

Effects of hepatic blood inflow on liver ultrastructure and regeneration after extensive liver resection in rats with cirrhosis.

The aim of the present study was to investigate the effects of hepatic blood inflow on liver function, liver ultrastructure and the regeneration of future liver remnant (FLR) following major hepatectomy in rats with liver cirrhosis. A rat model of cirrhosis was established through intraperitoneal injection of carbon tetrachloride for 8 consecutive weeks. Extensive liver resection and different blood inflow models by portal vein (PV) and/or hepatic artery (HA) stenosis were conducted on the cirrhosis rats. Animal models were constructed as follows: Control (group A), low-flow PV + high-flow HA (group B), low-flow PV + low-flow HA (group C), high-flow PV + high-flow HA (group D) and high-flow PV + low-flow HA (group E). Hepatic blood inflow was detected by laser speckle contrast analysis, liver function and pathological changes were analyzed, Masson staining was used to identify the fibrosis of the liver and Periodic acid-Schiff staining was used to identify glycogen synthesis and hepatocyte function. The liver cell ultrastructure was evaluated by transmission electron microscopy, and the expression of Ki-67 in hepatocytes and the weight of the FLR were recorded to determine the regeneration of the FLR. Five days after major hepatectomy and liver blood inflow modulation, pathological examination of the livers from groups B and C revealed less congestion and less extensive hepatocellular injury. The serum alanine aminotransferase level of group B at 1, 3 and 5 days after hepatectomy and blood inflow modulation was 460.9±31.7, 331.0±22.0 and 285.6±15.8 U/l, respectively (control group: 676.9±41.7, 574.9±28.0 and 436.1±32.7 U/l, respectively; P<0.05); the total bilirubin of group B at 1, 3 and 5 days was 20.4±1.5, 16.1±1.0 and 13.5±0.6 µmol/l, respectively (control group: 30.3±1.4, 26.5±0.8 and 22.1±1.2 µmol/l, respectively; P<0.05). The size of the endoplasmic reticulum in the low-flow PV groups increased significantly and the mitochondrial swelling was alleviated. The positive rate of Ki-67 in the hepatocytes of groups B, C and D was 23.9±3.6, 15.7±2.3 and 12.9±2.4%, respectively (control group: 10.1±2.1%, P<0.05), and the positive rate of Ki-67 in group E was 6.1±1.4% (compared with that of the control group, P<0.05). The remnant liver weight of group B was 15.4±1.0 g (compared with that of the control group, P<0.05). Therefore, decreased portal blood flow combined with increased hepatic arterial blood flow alleviated the congestion in the liver following major hepatectomy in cirrhotic rats, improved the pathological status and liver function, increased the expression of Ki-67 and promoted liver regeneration.

Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts.

Partial liver grafts used in living donor liver transplantation (LDLT) may have multiple hepatic artery (HA) stumps. This study was designed to validate the safety of partial reconstruction of multiple HAs in pediatric LDLT cases. From January 2000 to June 2014, 136 pediatric LDLT recipients were categorized into three groups: single HA group (Group 1, n = 74), multiple HAs with total reconstruction group (Group 2, n = 23), and multiple HAs with partial reconstruction group (Group 3, n = 39). Partial reconstruction was performed only when there was pulsatile back-bleeding after larger HA reconstruction and sufficient intrahepatic arterial flow was confirmed by Doppler ultrasound (DUS). There was no significant difference in biliary complication rate, artery complication rate, patient survival, and graft survival among these groups. Risk factor analysis revealed that the presence of multiple HAs and partial reconstruction of multiple HAs were not risk factors of biliary anastomosis stricture. In conclusion, partial reconstruction of HAs during pediatric LDLT using a left liver graft with multiple HA stumps does not increase the risk of biliary anastomosis stricture or affect graft survival when intrahepatic arterial communication is confirmed by pulsatile back-bleeding and DUS.

Reconstructing single hepatic artery with two arterial stumps: biliary complications in pediatric living donor liver transplantation

Liver grafts can at times have two hepatic arterial stumps. This can result in a dilemma whether to reconstruct single or both the arteries. Hepatic artery (HA) thrombosis is the most dreaded complication in pediatric living donor liver transplantation (LDLT) as it can result in biliary complications and subsequent graft loss. We herein report the feasibility of reconstructing single hepatic artery in pediatric living donor liver transplantation having two arterial stumps in the liver graft. From 2008 to 2010, 87 pediatric patients undergoing LDLT were divided into three groups. Group 1 (n = 20): two HA stumps with two HA reconstruction, Group 2 (n = 22): two HA stumps with one HA reconstruction and Group 3 (n = 45): one HA stump with one HA reconstruction. The decision regarding the reconstruction of single or multiple HAs was made depending on the pre-operative radiological and intraoperative assessments. The incidence of HA thrombosis (p = 0.126) and biliary complications (p = 0.617), was similar in the three groups. Single HA reconstruction does not increase the risk of biliary strictures in pediatric LDLT recipients having dual hepatic arterial stumps in the liver graft.

Postoperative arterial hemorrhage after pancreatoduodenectomy: Report of five cases

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

Intermittent negative pressure external drainage of the pancreatic duct reduces pancreatic fistula after pancreaticojejunostomy in the patients with soft pancreas

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

Clinical Implications of an Aberrant Right Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy

Sometimes, it seems to be difficult to preserve the aberrant hepatic artery (HA) during pancreaticoduodenectomy (PD), with respect to en bloc lymph node dissection, especially in the case of aberrant right hepatic artery (RHA). Therefore, we evaluated the influence of incomplete en bloc lymph node (LN) dissection when aberrant RHA arises. We reviewed 103 patients with mid-to-distal common bile duct (CBD) cancers who underwent PD by one surgeon at Asan Medical Center from December 1994 to November 2005 (73 men, 30 women; mean age, 61.1 +/- 9.4 (range: 40-84) years). The mean follow-up period was 32.7 months. We compared the normal RHA group with the aberrant RHA group. Eighty-eight cases showed normal RHA anatomy, including nine cases (8.7%) of aberrant left hepatic artery (LHA) with normal RHA cases (normal HA group). RHA anomalies were observed in 15 cases (14.6%, aberrant HA group). In all cases, there was no direct invasion of cancer to aberrant HA. Among two groups, 43 cases (41.7%) showed recurrence and there was no significant difference in recurrence between two groups (p = 0.202). Three-year and 5-year overall survivals were 33.3% and 28.5% in the normal HA group, whereas 47.1% and 28.3% in the aberrant RHA group, respectively. There also was no statistically significant difference in survival (p = 0.763). When performing PD for CBD cancer, aberrant RHA should be preserved if there was no cancerous invasion and it does not seem to affect the recurrence of disease and overall survival of patients.

Analysis of respiration-related movement of upper abdominal arteries: preliminary measurement for the development of a respiratory motion compensation technique of roadmap navigation

In this study, we analyzed the respiratory motion of the upper abdominal arteries preliminary to developing a method of respiratory motion correction for the roadmap technique used in vascular interventions. We retrospectively obtained six digital angiography sequences taken during respiration. The levels of the right and left hemidiaphragms and the positions of artery bifurcation points were measured manually through each sequence. Artery bifurcation points were classified as the hepatic artery group (HAG), splenic artery group (SAG), and celiac group (CG). Correlations between the motions of each hemidiaphragm and of the artery bifurcation points in each group were determined. We found that the vertical motion of the HAG and CG matched that of the right hemidiaphragm (r = 0.924 and r = 0.888, respectively). The vertical motion of the SAG matched that of the left hemidiaphragm (r = 0.949). The mean horizontal movements for all groups were up to 1.90 mm. The vertical motion for each group matched that of the right or the left hemidiaphragm. These findings will facilitate the development of a method of respiratory motion correction for the roadmap technique.

Hepatobiliary Toxicity of 5-Fluoro-2??-Deoxyuridine

Biliary sclerosis remains the dose-limiting toxicity in a subset of patients receiving hepatic arterial (HA) floxuridine (FUDR) for the treatment of hepatic malignancy. To investigate the etiology of FUDR-associated sclerosing cholangitis, portal vein catheters were placed in mixed-breed hounds (N = 4) and connected to an implanted infusion pump system. Floxuridine 0.3 mg/kg/day was infused for 49 to 77 days each, as a continuous infusion. Cholangiograms were performed before and after infusion, and weekly liver function tests were obtained. The results were compared to dogs (N = 6) that received HA FUDR 0.3 mg/kg/d x 30 days, and dogs (N = 5) that received HA saline for 100 days. Elevation in the serum glutamic pyruvic transaminase and alkaline phosphatase, indistinguishable from the HA group, was seen in all four dogs with portal vein infusion. Maximum bilirubin levels ranged from 0.6 to 3.0 (mean 1.7), compared to a range of 6.4 to 28 (mean 13.4) for the HA dogs. Cholangiograms demonstrated hepatic volume loss consistent with hepatocellular injury, but no biliary sclerosis. These data suggest that sclerosing cholangitis resulting from intra-arterial infusion of FUDR is unlikely to be due to metabolites of the drug excreted in the bile, but due to direct toxicity to the biliary tree.