Systemic and regional hemodynamics in pigs with acute liver failure and the effect of albumin dialysis

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Item Type:	Article
Title:	Systemic and regional hemodynamics in pigs with acute liver failure and the effect of albumin dialysis
Creators Name:	Ytrebo, L.M., Sen, S., Rose, C., Davies, N.A., Nedredal, G.I., Fuskevaag, O.M., Ten Have, G.A.M., Prinzen, F.W., Williams, R., Deutz, N.E.P., Jalan, R. and Revhaug, A.
Abstract:	Objective. Acute liver failure (ALF) is haemodynamically characterized by a hyperdynamic circulation. The aims of this study were to investigate the systemic and regional haemodynamics in ALF, to measure changes in nitric oxide metabolites (NO(x)) and to evaluate whether these haemodynamic disturbances could be attenuated with albumin dialysis. Material and methods. Norwegian Landrace pigs (23–30 kg) were randomly allocated to groups as controls (sham-operation, n=8), ALF (hepatic devascularization, n=8) and ALF + albumin dialysis (n=8). Albumin dialysis was started 2 h after ALF induction and continued for 4 h. Systemic and regional haemodynamics were monitored. Creatinine clearance, nitrite/nitrate and catecholamines were measured. A repeated measures ANOVA was used to analyse the data. Results. In the ALF group, the cardiac index increased (P(GT)<0.0001), while mean arterial pressure (P(G)=0.02) and systemic vascular resistance decreased (P(GT)<0.0001). Renal resistance (P(G)=0.04) and hind-leg resistance (P(GT)=0.003) decreased in ALF. There was no difference in jejunal blood flow between the groups. ALF pigs developed renal dysfunction with increased serum creatinine (P(GT)=0.002) and decreased creatinine clearance (P=0.02). Catecholamines were significantly higher in ALF, but NOx levels were not different. Albumin dialysis did not attenuate these haemodynamic or renal disturbances. Conclusions. The haemodynamic disturbances during the early phase of ALF are characterized by progressive systemic vasodilatation with no associated changes in metabolites of NO. Renal vascular resistance decreased and renal dysfunction developed independently of changes in renal blood flow. After 4 h of albumin dialysis there was no attenuation of the haemodynamic or renal disturbances.
Keywords:	Albumin Dialysis, Artificial Organs, Hepatorenal Syndrome, Hyperdynamic Circulation, Animals, Swine
Source:	Scandinavian Journal of Gastroenterology
ISSN:	0036-5521
Publisher:	Taylor & Francis
Volume:	41
Number:	11
Page Range:	1350-1360
Date:	November 2006
Official Publication:	https://doi.org/10.1080/00365520600714527
PubMed:	View item in PubMed

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