Hepatic Denervation Induces Supersensitivity to Terbutaline of the Hepatic Arterial System in Conscious Dogs

Akiyama, Hideyuki; Nimura, Yuji; Murakami, Masahiko; Kawabata, Y; Κato, Masamichi; Hamaguchi, Katsura

doi:10.1006/jsre.1997.5005

Cited by 4 publications

(5 citation statements)

References 27 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, not only the advantages but also the hazards of the extended surgery should be carefully evaluated by both Eastern and Western surgeons because autonomic nerve dissection may confer some unknown effects on the surgical patients. 78,79 In conclusion, the Nagoya approach with aggressive preoperative management and an accurate staging system for hilar cholangiocarcinoma offers a high resectability rate with acceptable morbidity and mortality rates. It is suggested that long-term survivors even in the groups with positive lymph node metastasis or perineural invasion were achieved by extended surgery and careful perioperative management for difficult patients with advanced hilar cholangiocarcinoma.…”

Section: Discussionmentioning

confidence: 96%

“…Major liver resection with extended autonomic nerve and lymph node dissection has been performed in Nagoya University Hospital to overcome bile duct carcinoma with perineural invasion, which is an inherent characteristic and major prognostic factor of biliopancreatic cancers,76,77 and we have emphasized here some benefits of this type of surgery. However, not only the advantages but also the hazards of the extended surgery should be carefully evaluated by both Eastern and Western surgeons because autonomic nerve dissection may confer some unknown effects on the surgical patients 78,79…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

Nimura

Kamiya

Kondo

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

Self Cite

364

298

View full text Add to dashboard Cite

From 1977 to 1997, surgical resection was possible in 142 (80%) of 177 patients with hilar cholangiocarcinoma after relieving jaundice by single or multiple percutaneous transhepatic biliary drainage followed by percutaneous transhepatic cholangioscopy and/or percutaneous trans-hepatic portal vein embolization. Curative resection was possible in 108 (61%) of the 142 patients, and 100 of these patients underwent various types of hepatectomy with caudate lobectomy for a 30-day operative mortality rate of 6% and 9% hospital mortality. Combined portal vein resection was carried out in 43 cases including 41 hepatectomies and 2 bile duct resections. Hepatopancreatoduodenectomy was performed in 16 patients. Cancer recurrence was observed in 58 of the 108 patients undergoing curative resection. The 3-, 5-, and 10-year survival rates for 100 patients undergoing curative hepatectomy and 8 with curative bile duct resection were 43%, 26%, and 19%; and 31%, 16%, and 0%, respectively; those for 40 patients with positive lymph node metastasis, 84 with perineural invasion, and 43 with combined portal vein resection were 27%, 14%, and 7%; 34%, 21%, and 13%; and 18%, 6%, and 0%, respectively. These survival rates are significantly better than those for 35 patients with unresectable cancer. Curative resection after aggressive preoperative management is recommended as a reasonable surgical approach to hilar cholangiocarcinoma.

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

Nimura

Kamiya

Kondo

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

Self Cite

364

298

View full text Add to dashboard Cite

show abstract

“…Hepatic denervation in dogs followed by an intravenous infusion of terbutaline (β2 receptor agonist) results in a more important increase in hepatic artery and venous blood flow compared with normal innervated rats (Akiyama et al, 1997). This suggests that the denervated liver is more sensible toward β2 receptor agonists.…”

Section: Effect Of Hepatic Denervation In Experimental Animal Modelsmentioning

confidence: 99%

Transplanted liver: Consequences of denervation for liver functions

et al. 2004

View full text Add to dashboard Cite

Following liver transplantation, all hepatic nerves are transected; thus, liver allografts are completely isolated from neural control of their hosts. Despite this absolute denervation, liver allograft function does not appear to be significantly impaired after successful transplantation. In experimental animal models, hepatic denervation has no major effects on bile acid production and biotransformation, while it increases blood pressure and salt retention; decreases the number of hepatic progenitor cells, cholangiocyte proliferation, and liver regeneration; and influences the hepatic microcirculation, diet behavior, and glycemic control. In humans, hepatic denervation after liver transplantation has no major deleterious effects on bile secretion, liver regeneration, and hepatic blood flow. Insulin resistance and postprandial hyperglycemia, changes in ingestion behavior, and reduced stimulation of hepatic progenitor cells in the canals of Hering are the major side effects of absent liver innervation. Despite these abnormalities, patients can lead a new life with improved quality of life. © 2004 Wiley-Liss, Inc. Key words: liver transplantation; denervation; function; hepaticLiver transplantation is the ultimate treatment for patients with acute fulminant and chronic liver failure. The results of liver transplantation are good, with a 1-year survival of 90 -95% and a 10-year survival of 50 -60%. Because of a shortage in cadaveric donors, living-related liver transplantation is a good option to overcome this problem.The autonomic nerves of the liver are formed by an anterior plexus (around the hepatic artery) and a posterior plexus (surrounds portal vein and bile duct). Parasympathetic nerves are derived from the vagus nerve and the sympathetic fibers from the celiac ganglion. Sensory nerve endings are present in the liver capsule, central veins, and bile ducts. Most of the afferent nerves from the liver run via the vagus and splanchnic nerves, but some also to the right phrenic nerve. The afferent nerves register information from nocireceptors, osmo-and baroreceptors, as well as ionic and metabolic receptors (Bathal and Grossman, 1999).Following liver transplantation, the hepatic nerves are inevitably transected below the porta hepatis or at the hepatoduodenal ligament; thus, liver allografts are completely isolated from the neural control of their hosts. Despite this absolute denervation, the liver allograft does not appear to be significantly compromised after successful transplantation. There is no obvious deficiency in the regulation of liver metabolism (production of proteins such as albumin and coagulation factors, metabolization) and bile production. At first blush, it seems that under normal circumstances, hormones and substrates reaching the liver by circulation are responsible for control of the organ function, and that the role of hepatic nerves is mainly restricted to situations of physiological stress.However, a more profound search revealed that hepatic denervation has a lot of consequences...

show abstract

“…This would explain the susceptibility of sinusoidal blood flow to the effects of adrenergic antagonists in cirrhosis despite a lack of direct innervation. 31,32 However, increased nerve fiber density in fibrous septa and around portal veins has been described in cirrhosis, 33,34 but its role in controlling liver circulation has not been fully elucidated. Clearly, more studies are required on the importance of neurocontrol of the hepatic circulation in cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…Because stellate cells express both alpha‐adrenoceptors and beta‐adrenoceptors, contraction and/or relaxation of the sinusoidal walls in cirrhotic nodules can occur in an innervation‐independent way. This would explain the susceptibility of sinusoidal blood flow to the effects of adrenergic antagonists in cirrhosis despite a lack of direct innervation . However, increased nerve fiber density in fibrous septa and around portal veins has been described in cirrhosis, but its role in controlling liver circulation has not been fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic response to propranolol in patients with recurrent hepatitis C virus-related cirrhosis after liver transplantation: A case-control study

et al. 2013

View full text Add to dashboard Cite

Cirrhosis recurrence is frequent after orthotopic liver transplantation for hepatitis C virus (HCV). Because transplantation causes liver denervation, we hypothesized that the response to propranolol might differ in transplant patients versus nontransplant patients with cirrhosis and portal hypertension. Twenty-one patients with cirrhosis recurrence after orthotopic liver transplantation with portal hypertension were compared to 20 nontransplant patients with cirrhosis, HCV, and portal hypertension, and they were matched by sex, age, presence of varices, and Child-Pugh score. The patients underwent systemic and hepatic hemodynamic measurements at the baseline and 20 minutes after intravenous propranolol (0.15 mg/kg). At the baseline, the transplant patients with cirrhosis had a lower hepatic venous pressure gradient (HVPG) than the nontransplant patients with cirrhosis (14.8 6 2.9 versus 17.3 6 4.4 mm Hg, P 5 0.03) but a higher mean arterial pressure (MAP; 100.3 6 12.3 versus 91.8 6 11.6 mm Hg, P 5 0.04) and higher systemic vascular resistance (2253 6 573 versus 1883 6 525 dyn/second/cm 25 , P 5 0.03). There were no differences in the cardiac index (CI). Propranolol significantly decreased HVPG to similar extents in transplant patients and nontransplant patients with cirrhosis (214.1% 6 8.0% versus 216.9% 6 9.5%, P > 0.99). MAP tended to increase in transplant patients with cirrhosis, whereas it slightly decreased in nontransplant patients (5.1% 6 14.2% versus 24.8% 6 6.4%, P 5 0.007); however, the reduction in CI was less marked in transplant patients with cirrhosis (218.6% 6 7.6% versus 226.9% 6 9.0%, P 5 0.005). In conclusion, patients with HCV-related cirrhosis and portal hypertension after orthotopic liver transplantation have lower baseline HVPG values but similar HVPG responses to propranolol infusions in comparison with nontransplant patients with cirrhosis. In contrast to nontransplant patients, propranolol increases the systemic vascular resistance and arterial pressure in transplant patients with cirrhosis and attenuates the fall in CI.

show abstract

Hepatic Denervation Induces Supersensitivity to Terbutaline of the Hepatic Arterial System in Conscious Dogs

Cited by 4 publications

References 27 publications

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

Transplanted liver: Consequences of denervation for liver functions

Hemodynamic response to propranolol in patients with recurrent hepatitis C virus-related cirrhosis after liver transplantation: A case-control study

Contact Info

Product

Resources

About