Effect of Increased Hepatic Blood Flow Upon Liver Regeneration

The ECK fistula in animals and humans

“…By replacing the diverted splanchnic venous blood with an inflow from the inferior vena cava to the hepatic end of the portal vein (Fig 4), Child et al avoided most of the adverse effects of Eck's fistula. These studies 24 and those of Fisher and his associates 25,26 gave firm support to the concept that the quality of portal venous inflow was not a prime determinant of hepatic structure, function, or the capacity for regeneration. In some of Fisher's experiments involving end points of regeneration, the diverted portal blood was replaced by arterializing the hilar portal stump.…”

“…In some of Fisher's experiments involving end points of regeneration, the diverted portal blood was replaced by arterializing the hilar portal stump. 25 Subsequent workers accepted that the quantity of total hepatic blood flow was the main consideration in supporting liver health. This acceptance was maintained in spite of the demonstration that canine livers after venous transposition actually showed centrilobular atrophy, 24 and major deglycogenation, 27, 28 and thus were not in fact normal.…”

“…At the same time, the protection afforded after portal diversion by flow augmentation procedures such as Child's portacaval transposition 24 or Fisher's portal arterialization 25 was explained. If insulin and other hepatotrophic substances were bypassed around a single liver they would be returned to it in a diluted form in direct relation to the total hepatic blood flow, which these procedures increased.…”

Animal Research in Liver Transplantation with Special Reference to the Dog

“…7 The results obtained in animals were inferior to those with orthotopic allografts, partly because the extra graft atrophied rapidly. 8,9 One hypothesis was that the atrophy of the liver was the result of an inadequate portal flow, 10,11 but experiments from our laboratory first suggested 8,9 and then proved 12 that the liver atrophied from interliver competition in which the extra liver failed to receive some metabolite or other substance in the portal blood.…”

Prometheus and Pandora?together again

“…24 -26,37 Why, calculations were even made to show that replicating mature hepatocytes could indeed support Prometheus's eagle. 36 Next to be examined was the role of endocrine and other circulating regulatory factors, 31,44 including humors in portal blood 45 and hepatic blood flow, per se 46 in the quest for key growth factors that turn on and switch off liver regeneration. 28,31,47 More recently, attention has turned to immediate early genes, delayed early genes, and cell cycle genes, as well as transcription factors, which all play permissive roles in DNA replication and hepatocyte mitosis, since it appears that liver cells must first be "primed" to take advantage of growth factor effects.…”