Relation of the Portal Blood to Liver Maintenance

Abstract

In the course of observations on the r61e of the liver in blood formarion and destruction, we have had occasion to ligate portal branches to the organ. The ensuing changes have been of such striking character as to merit study for their own sake; and the present paper is concerned with them. There already exists, of course, a considerable literature on so obvious a theme. For the moment it m a y suffice to state in this connection that according to the generally accepted view occlusion of a portal branch to the liver has no effect on the organ save when a grave derangement of the systemic circulation is also present. The complete local parenchymal atrophy that in our experiments regularly followed such occlusion was unforeseen, as was the further observation that the atrophy is conditional, being dependent upon a compensatory hypertrophy of the remainder of the organ. Method.The liver of the rabbit is singularly adapted for experiments involving the blood vessels and bile ducts, since it consists of two separate masses, each with its own vessels and ducts. The rabbit may indeed for operative purposes be said to possess two livers. They are of very unequaI size, the larger, or main liver, as we shall call it, formed of the left anterior and posterior lobes and the right anterior lobe with the gall bladder, being three times as big as the smaller, or lobe mass, which consists of the right posterior and caudate lobes. The lobe mass contains just enough parenchyma, as Ponfick 1 showed, to suffice for the

Portal branch ligation with a continuous hepatocyte growth factor supply makes extensive hepatectomy possible in cirrhotic rats

“…Although reducing the hepatic volume to be resected would lower the incidence of this complication, it might raise the risk of intrahepatic recurrence, and increase the number of patients who could not undergo curative surgeries. Therefore, the enlargement of the safely resectable limit in a cirrhotic liver has been an important goal to improve the survival rate of patients with HCC.Preoperative percutaneous transhepatic portal embolization (PTPE), a modification of portal branch ligation (PBL), [3][4][5] has been used clinically to increase the proportion of the remaining liver before hepatectomy in patients with biliary tract cancer, metastatic liver tumors, or HCC who have undergone extensive hepatic resection to prevent postoperative liver failure. 6-9 However, PTPE would not be effective for a cirrhotic liver, because the compensatory hypertrophy of the unaffected lobes depends on their own regenerating ability.…”

“…Preoperative percutaneous transhepatic portal embolization (PTPE), a modification of portal branch ligation (PBL), [3][4][5] has been used clinically to increase the proportion of the remaining liver before hepatectomy in patients with biliary tract cancer, metastatic liver tumors, or HCC who have undergone extensive hepatic resection to prevent postoperative liver failure. [6][7][8][9] However, PTPE would not be effective for a cirrhotic liver, because the compensatory hypertrophy of the unaffected lobes depends on their own regenerating ability.…”

Review: Research Toward Safer Resectionof the Cirrhotic Liver

“…In a rat model that dates back to 1920, ligation of one main portal venous branch led to atrophy of the lobes supplied by the branch. Of note, the other, non-ligated lobes were stimulated to hypertrophy [64]. Since then, the importance of hepatotrophic factors found in portal blood has been well established [65].…”

The ECK fistula in animals and humans

“…Larimore 21 were intrigued by the possibilities that portal venous blood might contain hepatotrophic factors and that the extrahepatic diversion of these factors by portacaval shunt could be responsible for the hepatic atrophy and the poor health of animals with Eck's fistula. In 1924 they wrote, "Is the liver atrophy functional?…”

“…Whipple, who became a Nobel Laureate for work in the treatment of pernicious anemia, was the founding dean of the University of Rochester School of Medicine. He died on Jan. 21,1976, at age 97. him. 22,23 Mann envisioned the liver mass as a byproduct of, or a kind of encrustation upon, its complex capillary bed, which in turn was controlled solely by the volume of blood presented to it.…”