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Vascular Liver Disease pp 65–75Cite as

Circulatory Injury in Liver Transplantation

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Abstract

Optimum graft function after liver transplantation is dependent on ­adequate sinusoidal perfusion. Hepatic microcirculation may be compromised by several factors such as cold ischemia, quality of the liver graft, handling of the organ during surgery, surgical procedure, and reperfusion injury. This chapter will focus on the pathological consequences of cold preservation and reperfusion injury on hepatic microcirculation. Microcirculatory ­dysfunction in grafts donated after cardiac death as well as steatotic grafts will be underlined. We will summarize the effects of graft manipulation and denervation during surgery. Furthermore, we will discuss the contribution of microcirculatory failure to graft rejection. Finally, recent advances in visualization and assessment of human hepatic microcirculation will be highlighted.

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Abbreviations

DCD:

Donation after cardiac death

I/R:

Ischemia/reperfusion

OLT:

Orthotopic liver transplantation

PG:

Prostaglandin

TNF:

Tumor necrosis factor

ROS:

Reactive oxygen species

TX:

Thromboxane

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Zurich, Ramistrase 100, CH-8091, Zurich, Switzerland

    Pierre-Alain Clavien

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  1. Ashraf Mohammad El-Badry
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  2. Philipp Dutkowski
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  3. Pierre-Alain Clavien
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Correspondence to Pierre-Alain Clavien .

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Editors and Affiliations

  1. Keck School of Medicine, Div. GI & Liver Diseases, University of Southern California, Los Angeles, 90033, California, USA

    Laurie D. DeLeve

  2. , Section of Digestive Diseases, Yale University School of Medicine, New Haven, 06520, Connecticut, USA

    Guadalupe Garcia-Tsao

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El-Badry, A.M., Dutkowski, P., Clavien, PA. (2011). Circulatory Injury in Liver Transplantation. In: DeLeve, L., Garcia-Tsao, G. (eds) Vascular Liver Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8327-5_5

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