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Liver Unit, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Université de Montréal, Montréal, Québec, Canada H2X 1P1
Occlusion of a lobar portal vein is known to
induce atrophy of downstream liver lobes and hypertrophy of
contralateral lobes. Changes in portal flow are known to be compensated
by changes in hepatic arterial flow, thus defining the hepatic artery
buffer response (HABR). To understand the role of liver flow in liver atrophy, we measured portal flow and hepatic artery flow after different degrees of left portal vein stenosis (LPVS).
Surgery was performed to obtain 0, 43, 48, 59, 68, 72, 78, and 100%
LPVS. Systemic and splanchnic blood flows were measured at 4 h or 7 days after surgery using radiolabeled microspheres. At 4 h, LPVS produced no changes in systemic hemodynamics. Increasing degrees of
LPVS produced a significant decrease in left portal flow
(P < 0.0001) and a fully
compensatory increase in right portal flow (P < 0.0001) without significantly
affecting total portal flow. Left hepatic artery flow increased by
210% (P = 0.002), and right hepatic
artery flow decreased by 67% (P = 0.05) after full LPVS. There was a significant inverse correlation
between portal and arterial flow changes induced by different degrees
of LPVS in the left
(r2 = 0.61) and
right (r2 = 0.41)
lobes. Despite this HABR, we observed a reduction in left liver flow
(
45%; P = 0.01) and an
increase in right liver flow (+230%;
P = 0.01) with 100% LPVS. At 7 days,
a significant decrease in the weight of left liver lobes (
75%;
P < 0.0001) and a compensatory
increase in the weight of the right lobes (+210%; P < 0.0001) were observed with 100%
LPVS. Left and right liver flows were similar to results measured at 4 h, and HABR was still present. However, when expressed per gram of
liver, liver flows were identical to results obtained with sham
animals. Reduction in lobar portal flow is accompanied by an increase
in ipsilateral hepatic artery flow and a compensatory increase in
portal flow to the rest of the liver. In a given lobe, when
compensatory HABR is overcome, liver weight changes occur so that at
the end total liver flow per gram of liver tissue is restored. This
suggests that in normal conditions liver flow is a major regulator of
liver volume.
liver flow; liver atrophy; liver regeneration
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