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Decreased splanchnic oxygen uptake and increased systemic oxygen uptake in cirrhosis are normalized after liver transplantation
Author(s) -
Tietge Uwe J.F.,
Bahr Matthias J.,
Manns Michael P.,
Böker Klaus H.W.
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.29349
Subject(s) - splanchnic , cirrhosis , medicine , liver transplantation , transplantation , splanchnic circulation , portal venous pressure , gastroenterology , indocyanine green , blood flow , portal hypertension , surgery
The aim of this study is to (1) characterize the impact of orthotopic liver transplantation (OLT) on splanchnic and systemic oxygen uptake (V O 2 ) in patients with liver cirrhosis, and (2) investigate possible influencing factors, as well as metabolic consequences, of reduced splanchnic V O 2 in patients with cirrhosis. Therefore, we measured systemic V O 2 (indirect calorimetry), portal pressure (hepatic venous pressure gradient), hepatic blood flow (HBF; primed continuous infusion of indocyanine green), and hepatic turnover (arteriohepatic venous concentration differences multiplied by HBF) of oxygen, glucose, free fatty acids (FFAs), and aromatic amino acids (AAAs) in 52 patients with advanced cirrhosis and 16 patients with a clinically stable long‐term course after OLT. Systemic V O 2 was significantly increased in patients with cirrhosis (261 ± 7 mL/min) and normalized after OLT (216 ± 8 mL/min; P < .001). Arterial and hepatic venous oxygen saturation and splanchnic oxygen extraction (in percent) were not different between patients with cirrhosis and after OLT. Splanchnic V O 2 was decreased in patients with cirrhosis (41 ± 3 mL/min, representing 16% ± 1% of systemic V O 2 ) and normalized after OLT (69 ± 6 mL/min; P < .001, representing 32% ± 3% of systemic V O 2 ; P < .001). In patients with cirrhosis, a decrease in HBF was associated with decreased splanchnic V O 2 ( r = 0.74; P < .001). Conversely, decreased splanchnic V O 2 reflected a decrease in hepatic glucose production ( r = 0.34; P = .01) and hepatic extraction of FFAs ( r = 0.40; P < .01) and AAAs ( r = 0.30; P < .05). These results show that (1) splanchnic and systemic V O 2 normalize after OLT, indicating correction of hepatic and extrahepatic metabolic derangements; (2) in cirrhosis, HBF becomes limiting for hepatic oxygen supply; and (3) impaired splanchnic V O 2 reflects a decrease in metabolic liver function.