Autonomic Nervous System Tone Measured by Baroreflex Sensitivity Is Depressed in Patients With End-Stage Liver Disease

Barron, Hal V.; Alam, Imtiaz; Lesh, Michael D.; Strunk, A.; Bass, Nathan M.

doi:10.1111/j.1572-0241.1999.01000.x

Cited by 26 publications

(11 citation statements)

References 19 publications

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“…A study using the phenylephrine method did not show significant differences between cirrhotic patients (Child class B and C) and healthy subjects (26). In contrast, Barron et al (27) recently demontrated that BRS (evaluated by means of phenylephrine infusion) is markedly depressed in cirrhotics awaiting liver transplantation. Further interest has centered on the possible prognostic implications of autonomic dysfunction in cirrhosis.…”

Section: Discussionmentioning

confidence: 93%

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Stromal expression of urokinase‐type plasminogen activator receptor (uPAR) is associated with invasive growth in primary liver cancer

Akahane

Ishii

Ohtani

et al. 1998

Liver

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Aims/Buckground: Expression of urokinase-type plasminogen activator receptor (uPAR) was studied in 25 hepatocellular carcinomas (HCCs) and seven cholangiocellular carcinomas (CCCs) by immunohistochemistry. Methods und Results: uPAR was expressed mostly by host cells distributed along the tumour-host interface in all cases of HCC and CCC, and its expression was higher in CCC. These uPAR-positive cells were identified as macrophages by observation of serial sections stained for CD68, a marker for macrophages. Cancer cells were positive for uPAR in only one case of poorly differentiated HCC with sarcomatous changes and in three cases of CCC. Hepatocellular carcinomas were classified into two types: those with a fibrous capsule (expansive type) and those without a fibrous capsule (invasive type). Invasive-type HCCs showed more prominent expression of uPAR by macrophages than expansive HCCs (p

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Section: Discussionmentioning

confidence: 93%

“…A mouse monoclonal antibody directed against human uPAR was kindly provided by Dr. K. Dan0 (Finsen Lab., Copenhagen, Denmark) (27). Anti-CD68 monoclonal antibody (clone PG-M1) was purchased from DAKO (Copenhagen, Denmark).…”

Section: Anti Bodiesmentioning

confidence: 99%

Stromal expression of urokinase‐type plasminogen activator receptor (uPAR) is associated with invasive growth in primary liver cancer

Akahane

Ishii

Ohtani

et al. 1998

Liver

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“…Autonomic dysfunction has previously been described in patients with chronic liver disease of diverse aetiologies [27,[30][31][32]. The conventional view to date has been that the development of autonomic dysfunction in such patients is largely a consequence of the development of cirrhosis, rather than a feature of the individual underlying liver disease [46].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, fatigue is reported as a problem by the majority of patients with conditions characterized by abnormalities of blood pressure control such as primary autonomic failure [23]. Furthermore, autonomic dysfunction [identified as abnormality in autonomic function testing, impaired baroreflex sensitivity (BRS), or abnormality in blood pressure homeostasis] has been identified as an independent risk factor for cardiovascular mortality (particularly sudden cardiac death) in nonliver diseases [24][25][26] and has been found at increased prevalence in patients with chronic liver diseases including PBC [27][28][29][30][31][32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

Autonomic dysfunction in primary biliary cirrhosis correlates with fatigue severity

Newton

Davidson²,

Kerr

et al. 2007

European Journal of Gastroenterology & Hepatology

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“…Indeed, these patients have an attenuated vasoconstrictor response from volume receptors as the result of an overproduction of vasoactive agents 22 and an autonomic nervous system dysfunction. 23,24 As a consequence, patients in end-stage liver disease have a defective response to volemic changes. Therefore, we thought it would be of interest to propose a circuit alleviating volemic modifications by uncoupling the ex vivo liver perfusion from the systemic circulation.…”

Section: Discussionmentioning

confidence: 99%

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Lhuillier

Pouyet²,

Mechet³

et al. 2006

ASAIO Journal

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Performing an ex vivo liver perfusion as a transient liver support requires perfusing the liver with a flow of 1 ml/min per kg of liver, which could reach 25% of the cardiac output when a human liver is used. This high flow could be detrimental in patients with acute liver failure. Therefore, in an ischemic-induced liver failure pig model, we developed a circuit allowing low flows going out of and into the systemic circulation, whereas the flow going through the ex vivo liver is maintained at a high value. This was obtained by uncoupling the ex vivo circuit from the systemic circulation. Ex vivo liver perfusion was performed in a closed circuit with a flow averaging 1 ml/min per kg of ex vivo liver (700 to 800 ml/min, according to the weight of the livers we used). It was linked to the systemic circulation with input and output flows equal to that used during hemodialysis (200 ml/min). Compared with previously reported direct circuits, this perfusion system was well tolerated from a circulatory point of view. After the induction of ischemic liver failure, the ex vivo liver perfusion led to an increase in urea, branched amino acids to aromatic amino acid ratio, and fractional clearance of indocyanine green and galactose and to a decrease in ammonia and lactic acid. This system allowed the ex vivo liver to keep its clearing properties despite a low extracorporeal flow. It represents an extracorporeal circuit that could be used in place of the direct extracorporeal high-flow liver perfusion.

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Autonomic Nervous System Tone Measured by Baroreflex Sensitivity Is Depressed in Patients With End-Stage Liver Disease

Abstract: Vagal tone, as assessed by BRS, is markedly depressed in cirrhotic patients awaiting liver transplantation.

Cited by 26 publications

References 19 publications

Stromal expression of urokinase‐type plasminogen activator receptor (uPAR) is associated with invasive growth in primary liver cancer

Stromal expression of urokinase‐type plasminogen activator receptor (uPAR) is associated with invasive growth in primary liver cancer

Autonomic dysfunction in primary biliary cirrhosis correlates with fatigue severity

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

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