Skip to main content
NCBI home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1982 Dec;70(6):1234–1244. doi: 10.1172/JCI110722

Assessment of liver microcirculation in human cirrhosis.

P M Huet, C A Goresky, J P Villeneuve, D Marleau, J O Lough
PMCID: PMC370340  PMID: 7174791

Abstract

Alterations in the liver microcirculation were characterized by use of the multiple-indicator dilution technique in 25 cirrhotic patients undergoing hemodynamic evaluation of portal hypertension. Hepatic vein outflow dilution curves were obtained after portal vein or hepatic artery injections of a vascular reference substance (labeled erythrocytes) and of diffusible substances (labeled albumin and sucrose). In 23 of these patients (19 with alcoholic cirrhosis and 4 with postnecrotic cirrhosis), unimodal erythrocytes and albumin curves were obtained; the immediately accessible albumin space ranged from normal values (that were substantially larger than the erythrocyte space) to low values (that were little larger than the erythrocyte space). In parallel with this, the hepatic extraction of indocyanine green decreased and was correlated with the albumin space (r = 0.821, P less than 0.001). The form of labeled sucrose curves showed progressive changes indicating limited diffusion into the interstitial space. In contrast, bimodal curves were found in two patients (with macronodular cirrhosis); a large proportion of all labels appeared simultaneously in the early part of the outflow curves. Model analysis of the unimodal data indicated that the spectrum of findings could best be explained by progressive development of a barrier to exchange by progressive capillarization of the microvascular bed, and the form of the bimodal data suggested that large vessel shunting was occurring. Both changes, in turn, will contribute to the reduced extraction of protein-bound materials in cirrhosis.

Full text

PDF
1234

Images in this article

1242Image
on p.1242

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BENHAMOU J. P., NICOLLO F., URBANCZYK A., FAUVERT R. LE TRANSIT 'A TRAVERS LE FOIE HUMAIN DES 'ERYTHROCYTES ET DE L'ALBUMINE. ESSAI DE DISSECTION H'EMODYNAMIQUE DU FOIE. Rev Fr Etud Clin Biol. 1965 Mar;10:291–298. [PubMed] [Google Scholar]
  2. Baker K. J. Binding of sulfobromophthalein (BSP) sodium and indocyanine green (ICG) by plasma alpha-1 lipoproteins. Proc Soc Exp Biol Med. 1966 Aug-Sep;122(4):957–963. doi: 10.3181/00379727-122-31299. [DOI] [PubMed] [Google Scholar]
  3. Brace R. A. Fitting straight lines to experimental data. Am J Physiol. 1977 Sep;233(3):R94–R99. doi: 10.1152/ajpregu.1977.233.3.R94. [DOI] [PubMed] [Google Scholar]
  4. Branch R. A., Shand D. G. Propranolol disposition in chronic liver disease: a physiological approach. Clin Pharmacokinet. 1976;1(4):264–279. doi: 10.2165/00003088-197601040-00002. [DOI] [PubMed] [Google Scholar]
  5. CAESAR J., SHALDON S., CHIANDUSSI L., GUEVARA L., SHERLOCK S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci. 1961 Aug;21:43–57. [PubMed] [Google Scholar]
  6. GORESKY C. A. A linear method for determining liver sinusoidal and extravascular volumes. Am J Physiol. 1963 Apr;204:626–640. doi: 10.1152/ajplegacy.1963.204.4.626. [DOI] [PubMed] [Google Scholar]
  7. Goresky C. A., Bach G. C., Nadeau B. E. On the uptake of materials by the intact liver. The concentrative transport of rubidium-86. J Clin Invest. 1973 May;52(5):975–990. doi: 10.1172/JCI107299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Goresky C. A., Warnica J. W., Burgess J. H., Nadeau B. E. Effect of exercise on dilution estimates of extravascular lung water and on the carbon monoxide diffusing capacity in normal adults. Circ Res. 1975 Sep;37(3):379–389. doi: 10.1161/01.res.37.3.379. [DOI] [PubMed] [Google Scholar]
  9. Goresky C. A., Ziegler W. H., Bach G. G. Capillary exchange modeling. Barrier-limited and flow-limited distribution. Circ Res. 1970 Nov;27(5):739–764. doi: 10.1161/01.res.27.5.739. [DOI] [PubMed] [Google Scholar]
  10. Groszmann R. J., Kravetz D., Parysow O. Intrahepatic arteriovenous shunting in cirrhosis of the liver. Gastroenterology. 1977 Jul;73(1):201–204. [PubMed] [Google Scholar]
  11. Huet P. M., Du Reau A., Marleau D. Arterial and portal blood supply in cirrhosis: a functional evaluation. Gut. 1979 Sep;20(9):792–796. doi: 10.1136/gut.20.9.792. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Huet P. M., Marleau D., Lavoie P., Viallet A. Extraction of 125I-albumin microaggregates from portal blood. An index of functional portal blood supply in cirrhotics. Gastroenterology. 1976 Jan;70(1):74–81. [PubMed] [Google Scholar]
  13. MEIER P., ZIERLER K. L. On the theory of the indicator-dilution method for measurement of blood flow and volume. J Appl Physiol. 1954 Jun;6(12):731–744. doi: 10.1152/jappl.1954.6.12.731. [DOI] [PubMed] [Google Scholar]
  14. Orrego H., Blendis L. M., Crossley I. R., Medline A., Macdonald A., Ritchie S., Israel Y. Correlation of intrahepatic pressure with collagen in the Disse space and hepatomegaly in humans and in the rat. Gastroenterology. 1981 Mar;80(3):546–556. [PubMed] [Google Scholar]
  15. PHILLIPS M. J., STEINER J. W. ELECTRON MICROSCOPY OF LIVER CELLS IN CIRRHOTIC NODULES. I. THE LATERAL CELL MEMBRANES. Am J Pathol. 1965 Jun;46:985–1005. [PMC free article] [PubMed] [Google Scholar]
  16. POPPER H., ELIAS H., PETTY D. E. Vascular pattern of the cirrhotic liver. Am J Clin Pathol. 1952 Aug;22(8):717–729. doi: 10.1093/ajcp/22.8.717. [DOI] [PubMed] [Google Scholar]
  17. Rose C. P., Goresky C. A., Bach G. G. The capillary and sarcolemmal barriers in the heart. An exploration of labeled water permeability. Circ Res. 1977 Oct;41(4):515–533. doi: 10.1161/01.res.41.4.515. [DOI] [PubMed] [Google Scholar]
  18. Rose C. P., Goresky C. A. Constraints on the uptake of labeled palmitate by the heart. The barriers at the capillary and sarcolemmal surfaces and the control of intracellular sequestration. Circ Res. 1977 Oct;41(4):534–545. doi: 10.1161/01.res.41.4.534. [DOI] [PubMed] [Google Scholar]
  19. SCHAFFNER F., POPER H. Capillarization of hepatic sinusoids in man. Gastroenterology. 1963 Mar;44:239–242. [PubMed] [Google Scholar]
  20. Wood A. J., Villeneuve J. P., Branch R. A., Rogers L. W., Shand D. G. Intact hepatocyte theory of impaired drug metabolism in experimental cirrhosis in the rat. Gastroenterology. 1979 Jun;76(6):1358–1362. [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES