Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
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Split liver transplantation and living donor liver transplantation (LDLT) commonly use a right liver graft without the middle hepatic vein (MHV). Although tributaries of the MHV are not reconstructed in the majority of cases, the alterations of the microcirculation and its regional functions remain unknown. We addressed these issues by assessing liver tissue indocyanine green (ICG) uptake with near-infrared spectroscopy (NIRS) in 21 donors. ⋯ Roc/non was related to the extent of liver surface discoloration before and after hepatic arterial clamping (P = 0.03 and 0.01, respectively). In conclusion, sinusoidal perfusion was impaired in the veno-occlusive regions of living donor livers, but the magnitude of the effect varied greatly. Measurement of hepatic ICG uptake by NIRS could become a valuable tool for assessing the indication for venous reconstruction in LDLT and/or split donor liver transplantation.
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Hepatic ischemia reperfusion (IR) injury is a major clinical problem during the perioperative period and occurs frequently after major hepatic resection or liver transplantation. Exogenous and endogenous A(1) adenosine receptor (A(1)AR) activation protects against renal IR injury. In this study, we questioned whether exogenous and endogenous A(1)AR activation protects against hepatic IR injury in vivo. ⋯ However, in contrast to the kidneys, in which exogenous A(1)AR activation protected against IR injury, exogenous A(1)AR activation failed to protect against liver injury after IR. We conclude that endogenous A(1)AR activation prevents worsened murine liver IR injury primarily by reducing necrotic and apoptotic cell death. Harnessing the mechanisms of cytoprotection with endogenous A(1)AR activation may lead to new therapies for perioperative hepatic IR injury.