In Situ Hypothermic Perfusion with Retrograde Outflow During Right Hemihepatectomy: First Experiences with a New Technique

Reiniers, Megan J.; Golen, Rowan F. van; Heger, Michal; Mearadji, Banafsche; Bennink, Roelof J.; Verheij, Joanne; Gulik, Thomas M. van

doi:10.1016/j.jamcollsurg.2013.09.013

Cited by 12 publications

(7 citation statements)

References 31 publications

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“…1C). This is in line with results from a small HCC cohort with mixed etiology [6]. Interestingly, serum hepcidin levels were shown to be decreased in patients with chronic hepatitis C [7].…”

Section: Conflict Of Interestsupporting

confidence: 89%

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Solutions to the discrepancies in the extent of liver damage following ischemia/reperfusion in standard mouse models

Golen

Reiniers

Heger

et al. 2015

Journal of Hepatology

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Section: Conflict Of Interestsupporting

confidence: 89%

“…Firstly, such damage profiles are not clinically representative, given that peak postoperative ALT values in patients subjected to I/R rarely exceed ±1000-1500 U/L [5,6]; i.e., >10-fold lower than in most mouse models ( Fig. 1A-D).…”

mentioning

confidence: 99%

Solutions to the discrepancies in the extent of liver damage following ischemia/reperfusion in standard mouse models

Golen

Reiniers

Heger

et al. 2015

Journal of Hepatology

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“…VIO durations up to 2 h were well tolerated using this technique, enabling the removal of tumors that were otherwise considered not resectable, albeit at the expense of a considerable (10.3%) mortality rate. Consequently, only a small number of technical feasibility studies on IHP in stringently selected cases were published in the following years (7,72,73).…”

Section: Clinical Status Quo Of Organ Cooling In Liver Surgery Liver mentioning

confidence: 99%

“…Whereas the use of liver cooling for liver preservation and transplantation purposes are well known (see Liver Transplantation), livers can also be cooled in situ during liver resection by perfusing the organ with a chilled solution through the afferent hepatic vasculature. This technique is known as in situ hypothermic perfusion (IHP) (5), and various adaptations of this technique have been recently used to improve ischemic tolerance during major liver surgery (see Liver Resection) (6,7).…”

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confidence: 99%

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Olthof

Reiniers

Dirkes

et al. 2015

Mol Med

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Hepatic ischemia/reperfusion (I/R) injury is a side effect of major liver surgery that often cannot be avoided. Prolonged periods of ischemia put a metabolic strain on hepatocytes and limit the tolerable ischemia and preservation times during liver resection and transplantation, respectively. In both surgical settings, temporarily lowering the metabolic demand of the organ by reducing organ temperature effectively counteracts the negative consequences of an ischemic insult. Despite its routine use, the application of liver cooling is predicated on an incomplete understanding of the underlying protective mechanisms, which has limited a uniform and widespread implementation of liver-cooling techniques. This review therefore addresses how hypothermia-induced hypometabolism modulates hepatocyte metabolism during ischemia and thereby reduces hepatic I/R injury. The mechanisms underlying hypothermia-mediated reduction in energy expenditure during ischemia and the attenuation of mitochondrial production of reactive oxygen species during early reperfusion are described. It is further addressed how hypothermia suppresses the sterile hepatic I/R immune response and preserves the metabolic functionality of hepatocytes. Lastly, a summary of the clinical status quo of the use of liver cooling for liver resection and transplantation is provided.

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“…The directly proportional effect of Tb on Q is in turn affected by the ambient temperature (Ta), which impacts Tb and hence Q through heat exchange (Figure 2). The (Ta-)Tb-Q relationship is widely exploited in the clinical setting, as exemplified by the contrived reduction in patients' Tb through direct or indirect cooling (e.g., reduction in Ta by means of breathing cold air, cutaneous cooling, organ perfusion with a cold solution, or intravascular cooling) as a protective strategy in surgery [8,9], neurology [10], cardiology [11], trauma [12], and intensive care [13]. The protective effects of mild to moderate hypothermia (Tb reduction to ~35-32 °C) have been ascribed to lower radical production rates, ameliorated mitochondrial injury/dysfunction, reduced ion pump dysfunction, and cell membrane leakage, amongst others [14].…”

Section: Control Of Metabolism Through Temperature and Substrate Avaimentioning

confidence: 99%

The physiology of artificial hibernation

Heger

2015

JCTRes

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Incomplete understanding of the mechanisms responsible for induction of hibernation prevent translation of natural hibernation to its artificial counterpart. To facilitate this translation, a model was developed that identifies the necessary physiological changes for induction of artificial hibernation. This model encompasses six essential components: metabolism (anabolism and catabolism), body temperature, thermoneutral zone, substrate, ambient temperature, and hibernation-inducing agents. The individual components are interrelated and collectively govern the induction and sustenance of a hypometabolic state. To illustrate the potential validity of this model, various pharmacological agents (hibernation induction trigger, delta-opioid, hydrogen sulfide, 5'-adenosine monophosphate, thyronamine, 2-deoxyglucose, magnesium) are described in terms of their influence on specific components of the model and corollary effects on metabolism. Relevance for patients: The ultimate purpose of this model is to help expand the paradigm regarding the mechanisms of hibernation from a physiological perspective and to assist in translating this natural phenomenon to the clinical setting.

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In Situ Hypothermic Perfusion with Retrograde Outflow During Right Hemihepatectomy: First Experiences with a New Technique

Cited by 12 publications

References 31 publications

Solutions to the discrepancies in the extent of liver damage following ischemia/reperfusion in standard mouse models

Solutions to the discrepancies in the extent of liver damage following ischemia/reperfusion in standard mouse models

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

The physiology of artificial hibernation

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