Portal Triad Occlusion Induces Endotoxin Tolerance: Role of Portal Congestion

Unno, Naoki; Uchiyama, Takashi; Yamamoto, Naoto; Inuzuka, Kazunori; Sagara, Daisuke; Konno, Hiroyuki

doi:10.1016/j.jss.2006.03.042

Cited by 11 publications

(13 citation statements)

References 30 publications

(37 reference statements)

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“…These results are in agreement with other studies demonstrating that liver I/R plays an important role in cytokine liberation (Unno et al 2006;Sehirli et al 2008). On the other hand, when the integrity of the intestinal mucosal barrier is damaged, TNF-a and IL-1b levels are also increased (Yuan et al 2011).…”

Section: Discussionsupporting

confidence: 94%

Heparin-binding epidermal growth factor-like growth factor protects rat intestine after portal triad clamping

Liao

Chen

et al. 2013

Growth Factors

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Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent mitogen and chemotactic factor. HB-EGF attenuates intestinal ischemia/reperfusion injury caused by superior mesenteric artery occlusion. We examined whether HB-EGF offers protection against intestinal congestion/reperfusion (C/R) injury, which is caused by portal triad clamping. Male Sprague-Dawley rats were randomly divided into three equally sized groups: I, sham-operated; II, portal triad clamping (Pringle maneuver); III, II + intraluminal administration of HB-EGF. Compared with sham-operated rats, all rats in group II exhibited significant increases in intestinal histologic injury, pro-inflammatory cytokine expression, myeloperoxidase activity, malonaldehyde levels, and apoptosis indices. Intraluminal administration of HB-EGF in group III significantly reduced these indicators when compared with group II. Clamping of the portal triad followed by reperfusion causes intestinal C/R injury and intraluminal administration of HB-EGF reduces the severity of intestinal C/R injury in rats.

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Section: Discussionsupporting

confidence: 94%

Heparin-binding epidermal growth factor-like growth factor protects rat intestine after portal triad clamping

Liao

Chen

et al. 2013

Growth Factors

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“…Intestinal hypoperfusion leads to enterocyte damage and gut barrier loss [8]. The effect of splanchnic hypoperfusion on intestinal damage as a consequence of IPM has been proven in several animal studies [9]–[11]. Sheen-Chen et al [12] showed recently in rats that occlusion of the hepatoduodenal ligament significantly increased jejunal apoptosis.…”

Section: Introductionmentioning

confidence: 99%

Total Intermittent Pringle Maneuver during Liver Resection Can Induce Intestinal Epithelial Cell Damage and Endotoxemia

et al. 2012

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ObjectivesThe intermittent Pringle maneuver (IPM) is frequently applied to minimize blood loss during liver transection. Clamping the hepatoduodenal ligament blocks the hepatic inflow, which leads to a non circulating (hepato)splanchnic outflow. Also, IPM blocks the mesenteric venous drainage (as well as the splenic drainage) with raising pressure in the microvascular network of the intestinal structures. It is unknown whether the IPM is harmful to the gut. The aim was to investigate intestinal epithelial cell damage reflected by circulating intestinal fatty acid binding protein levels (I-FABP) in patients undergoing liver resection with IPM.MethodsPatients who underwent liver surgery received total IPM (total-IPM) or selective IPM (sel-IPM). A selective IPM was performed by selectively clamping the right portal pedicle. Patients without IPM served as controls (no-IPM). Arterial blood samples were taken immediately after incision, ischemia and reperfusion of the liver, transection, 8 hours after start of surgery and on the first post-operative day.Results24 patients (13 males) were included. 7 patients received cycles of 15 minutes and 5 patients received cycles of 30 minutes of hepatic inflow occlusion. 6 patients received cycles of 15 minutes selective hepatic occlusion and 6 patients underwent surgery without inflow occlusion. Application of total-IPM resulted in a significant increase in I-FABP 8 hours after start of surgery compared to baseline (p<0.005). In the no-IPM group and sel-IPM group no significant increase in I-FABP at any time point compared to baseline was observed.ConclusionTotal-IPM in patients undergoing liver resection is associated with a substantial increase in arterial I-FABP, pointing to intestinal epithelial injury during liver surgery.Trial RegistrationClinicalTrials.gov NCT01099475

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“…The use of pigs in our study was based on the advantages they offer regarding availability and somatometric characteristics comparable to humans [10]. Portocaval shunt was rendered mandatory to avoid splanchnic congestion as a contributing factor to the observed results [11,12]. The 70-80% resection was selected in order to simulate harsh conditions for the liver, which became extreme with the implication of I/R process; besides, a 85% resection is considered the limit beyond which the hepatic remnant cannot exert its metabolic function or regenerate [13,14].…”

Section: Discussionmentioning

confidence: 99%

Expression of Inflammatory and Regenerative Genes in a Model of Liver Ischemia/Reperfusion and Partial Hepatectomy

Athanasopoulos

Mastoraki²,

Papalois

et al. 2015

Journal of Investigative Surgery

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Portal Triad Occlusion Induces Endotoxin Tolerance: Role of Portal Congestion

Cited by 11 publications

References 30 publications

Heparin-binding epidermal growth factor-like growth factor protects rat intestine after portal triad clamping

Heparin-binding epidermal growth factor-like growth factor protects rat intestine after portal triad clamping

Total Intermittent Pringle Maneuver during Liver Resection Can Induce Intestinal Epithelial Cell Damage and Endotoxemia

Expression of Inflammatory and Regenerative Genes in a Model of Liver Ischemia/Reperfusion and Partial Hepatectomy

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