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To date, no method is available for the continuous long-term monitoring of liver microcirculation in patients. Experimentally, thermodiffusion has been validated in the quantification of hepatic perfusion. In an attempt to investigate the practicability of thermodiffusion technology in patients after liver transplantation thermodiffusion probes were inserted into the graft in seven patients during liver transplantation. Continuous monitoring started intraoperatively and was performed until day 7, when the probes were extracted transcutaneously. No probe-related complications (i.e., hemorrhage, infection) were observed. In four patients with normal graft function, liver perfusion recovered within 12 h from the intraoperative reduction to a range between 85 and 93 ml/100 g per min. In contrast, primary graft failure (n = 1) was characterized by a constant decrease of hepatic perfusion (< 50 ml/100 g per min). In prolonged reperfusion injury (n = 1), a second peak of transaminases was paralleled by an impairment of liver microcirculation. In one patient, R2 rejection on day 7 was preceded by a drop in hepatic perfusion 48 h earlier. Thus, thermodiffusion is a safe and reliable method for the continuous quantification of liver microcirculation after transplantation in patients. Measurements are reproducible for at least 7 days. Changes in hepatic perfusion during postoperative complications can be detected. The characteristics of microcirculatory disorders will have to be defined in a larger number of patients.

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High endothelin (ET) concentrations were recently detected in human bile after orthotopic liver transplantation (OLT). In the present study we compared biliary ET/big-ET levels measured by radioimmunoassay (RIA) in liver graft recipients (n = 37) with levels measured in non-transplant patients during cholecystectomy (n = 38) to clarify the influence of transplantation on the levels of biliary ET peptides. HPLC elution profiles of biliary ET were analyzed for characterization of ET peptide composition and validation of RIA analysis in bile extracts. Mean ET/big-ET levels in the common bile duct after OLT were significantly elevated (ET, 20.9 +/- 15; big-ET, 39.2 +/- 19 fmol/ml) compared to levels in non-transplant patients (ET, 5.7 +/- 4.9; big-ET, 12 +/- 8 fmol/ml). Highest ET/big-ET levels were measured in the gall bladder during cholecystectomy (ET, 61.7 +/- 41; big-ET, 75 +/- 28 fmol/ml). ET and big-ET levels were correlated by linear regression. HPLC analysis reveals the presence of high levels of ET/big-ET in human bile. Biliary ET mostly represents ET-1. High biliary ET levels after OLT appear to be derived from active endothelial secretion and probably reflect hepatic endothelial stress after preservation/ reperfusion. High biliary ET levels could be involved in the mediation of functional cholestatic syndromes after OLT.

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