Wirkung von Adrenalin und Noradrenalin auf die hepatische Mikro- und Makroperfusion in der frühen Phase nach experimenteller Lebertransplantation im Schweinemodell

Abstract

Application of catecholamines in the postoperative care after liver transplantation (LTx) does not only support systemic pressure but can also negatively affect microcirculation (MC) in visceral organs depending on the dosage applied. Whether MC in the early course after LTx is particularly sensitive to catecholamines due to the preceding ischemic/reperfusion injury has not been examined yet. In a porcine model we analyzed hepatic MC of transplanted livers as compared to the physiological Situation during i.v. catecholamine application. In the control group (16 healthy pigs) a laparotomy was performed and a systemic application of Adrenaline (ADR: n = 8) or Noradrenaline (NORADR: n = 8) followed. Another group of 16 animals received catecholamines on the first postoperative day after LTx. Over a time span of 240 min hepatic parenchymal MC was continuously assessed by thermodiffusion and transhepatic blood flow was measured using ultrasound probes. Hepatic MC remained stable in native livers under ADR application. Under NORADR there was a trend for MC reduction. In contrast, in transplanted livers we noted a significant reduction of hepatic MC by about 40% compared to baseline levels during ADR as well as NORADR. Changes in hepatic macrocirculation matched changes in MC. More pronounced disturbances of MC and macrocirculation after LTx might be explained by ischemia/reperfusion injury of transplanted livers or by loss of intrahepatic regulatory mechanisms due to denervation after organ harvesting. Application of catecholamines following LTx should therefore be carefully indicated. A continuous measurement of hepatic MC might be helpful due to hepatic vulnerability early after LTx.