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Hepatic ischemia/reperfusion injury has so far been investigated in various experimental models. A clinical transfer of experimental results is, however, problematic because of anatomical and physiological differences and also the inevitable simplification of experimental work. The choice of model must therefore be adapted to the clinical question to be answered. The simplest procedure for inducing normothermic ischemia is to clamp the hepatoduodenal ligament. Models that do not avert portal congestion are regarded as unsuitable. Our current understanding of the pathogenesis of ischemia/reperfusion injury depends mainly on studies whose authors have investigated either global liver ischemia with a portocaval shunt, spleen transposition and in the isolated perfused system, or partial ischemia. This review is a critical examination of various approaches to the study of normothermic hepatic ischemia in experimental animals.

Ischemia leads to profound endothelin- (ET) related constriction of hepatic microvessels, causing disturbances in blood and oxygen supply. The aim of the study was to modulate hepatic microvascular diameters by blocking ET receptors to find the optimal therapeutic vessel width for reduction of ischemia-reperfusion injury. In an in vivo model (84 female Wistar rats, 250-300 g) with portal decompression by means of a splenocaval shunt, normothermic hepatic ischemia was induced for 30 min by crossclamping of the hepatoduodenal ligament. The ET receptor antagonist (ERA) bosentan was administered before induction of ischemia in different dosages [0.1, 1.0 and 10.0 mg/kg body weight (BW) i.v. and 10 mg/kg BW intraportally (i.p.)]. The effect on microcirculation was assessed by in vivo microscopy and influence on hepatocellular function by measurement of aspartate aminotransferase (AST) levels. Sinusoidal diameters were reduced as a result of ischemia to 76.3 +/- 7.4% compared with values received from sham-operated animals. After application of 0.1 mg/kg of bosentan, sinusoids remained constricted (89.7 +/- 9.9%, AST 255.0 +/- 12.8 U/l). Blocking ET receptors with 1 mg/kg bosentan avoided sinusoidal constriction (99.0 +/- 8.8%, p < 0.05) and led to the most effective reduction of AST level peak after 6 h of reperfusion (244.0 +/- 34.2 U/l vs 422.9 +/- 163.3 U/l in untreated ischemia). Bosentan (10 mg/kg i.v.) caused an increase in sinusoidal diameter to 109.1 +/- 6.4% (AST 311.7 +/- 33.6 U/l) and 10 mg/kg i.p. to 136.8 +/- 19.3% and even increase AST levels (618.90 +/- 209.32 U/l). After intravenous application of 1 and 10 mg/kg BW bosentan the perfusion rate was significantly increased and sticking of leukocytes in sinusoids and venules reduced (p < 0.05). In our model, diameters of sinusoids and postsinusoidal venules could be regulated gradually. We conclude that the avoidance of constriction, but not an excessive vasodilation leads to increased perfusion rate and hence improved hepatocellular function.

During ischemia-reperfusion an imbalance between endothelin (ET) and nitric oxide (NO) can be responsible for microcirculatory disturbances. The aim of this study was to restore the ET/NO balance to reduce the ischemia-reperfusion injury. Hepatic ischemia was induced for 30 min in 56 Wistar rats. Sham operation, ischemia and treatment groups with the ET receptor antagonist (ERA) bosentan (1 mg/kg body weight i.v.) and the NO donor L-arginine (400 mg/kg body weight i.v.) were performed. For evaluation of hepatic microcirculation in vivo microscopy was carried out 30-90 min after reperfusion. Local hepatic tissue PO2, laser Doppler flow and aspartate aminotransferase/alanine aminotransferase (AST/ALT) levels were measured. Increased ET caused sinusoidal constriction after reperfusion to 76% of the sham group (p < 0.05), leading to significant decrease in perfusion rate (82%), liver tissue PO2 (6.9 mmHg) and erythrocyte flux (45.2% of sham group). Hepatocellular damage could be detected 6 h after reperfusion by AST/ALT increase (p < 0.05). Sinusoidal diameters were maintained at baseline in the ERA (98%) and NO (102%) groups (p < 0.05). Increased percentage of leukocytes sticking in sinusoids (144%) and venules (435%) was reduced by therapy to 110/253% (ERA) and 111/324% (NO), respectively (p < 0.05). Perfusion rate was increased to 93 and 94% (p < 0.05 vs ischemia). Local hepatic tissue PO2 was improved 30 min after reperfusion in the ERA (11.0 mmHg) as well as in the NO group (11.5 mmHg; p < 0.05 vs ischemia). Measurement with a laser Doppler flow meter revealed significant improved erythrocyte flux in both therapy groups (p < 0.05 vs ischemia). Also, the post-ischemic AST/ALT increase was reduced by therapy. In conclusion, ET evokes strong constriction of post-ischemic sinusoids, leading to microcirculatory disturbances. The maintenance of the ET/NO balance by blocking ET receptors, or providing an NO donor, protects liver microcirculation and reduces hepatic ischemia-reperfusion injury.

Unlabelled: Hepatic ischemia followed by reperfusion evokes an imbalance between the vasoregulatory compounds endothelin and nitric oxide (NO) followed by constriction of the vascular bed, leading to microcirculatory disturbances and reduced blood flow, thereby causing hypoxia and liver damage. The aim of this study was to protect the liver microcirculation by maintaining this delicate balance., Material and Methods: In an in vivo ischemia/reperfusion model with portal decompression by a splenocaval shunt, hepatic ischemia was induced for 30 min by Pringle's maneuver. The effect of the NO donor L-arginine (400 mg/kg b.w. i.v.) was assessed by in vivo microscopy. Microhemodynamic studies, including the sinusoidal perfusion rate, diameters of hepatic sinusoids and postsinusoidal venules, leukocyte endothelium interactions and leukocyte velocity were performed. Microcirculatory data were compared with local tissue pO2 and serum transaminase levels., Results: After ischemia the diameters of sinusoids and postsinusoidal venules were significantly reduced to 76+/-7 and 86+/-10% respectively in the nontreatment group, but dilated to 102+/-3 and 105+/-7% in the group treated with L-arginine (p < 0.001). The percentage of permanently adherent leukocytes in sinusoids and venules was increased by ischemia, but L-arginine reversed this increase (p < 0.001). Perfusion rate was improved to 90+/-2 compared with 83+/-5% in the untreated group (p < 0.01). Systemic arterial blood pressure was not affected by administration of the NO donor. The postischemic increase in serum transaminase levels was diminished in the treatment group (ASAT: p < 0.05). Local postischemic hepatic tissue pO2 was significantly decreased to 45% of basal values after 30 min and to 55% after 60 min of reperfusion (p < 0.05). Administration of L-arginine results in a significant increase in local tissue pO2 to 86 and 106% of basal values respectively (p < 0.05)., Conclusion: These data indicate that L-arginine improves hepatic microcirculation after warm ischemia by increasing sinusoidal perfusion rate and by diminishing leukocyte endothelium interactions. Maintained integrity of microcirculation is associated with sufficient oxygen supply and improved hepatocellular function.

Unlabelled: One mechanism evoked by ischemia is endothelin mediated vasoconstriction of the hepatic vascular bed. Postischemic sinusoidal constriction leads to microcirculatory disturbances and reduced blood flow, thereby causing local hypoxia and liver damage. The aim of the study was to avoid the constrictive response of sinusoids by blocking endothelin receptors., Material and Methods: In an in vivo ischemia-reperfusion-model (21 Wistar rats, 250-300 g) with portal decompression by a splenocaval shunt, hepatic ischemia was induced for 30 min by cross clamping of the hepatoduodenal ligament. The effect of the endothelin receptor antagonist bosentan (10 mg/kg bw i.v.) injected before ischemia was assessed by in vivo microscopy. Microhemodynamic studies, including the sinusoidal perfusion rate, diameters of hepatic sinusoids and postsinusoidal venules, leukocyte endothelium interactions and leukocyte velocity were performed., Results: After ischemia sinusoidal diameters and diameters of postsinusoidal venules were significantly reduced to 76 +/- 7% and 86 +/- 10%, respectively, in the non-treatment group, but dilated to 109 +/- 6% and 118 +/- 8% in the group treated with endothelin receptor antagonist (p < 0.001). Increased percentage of postischemic permanent adherent leukocytes could be diminished in sinusoids and more markedly in venules by therapy (p < 0.001). Leukocyte velocity was decreased to 69 +/- 9% in the treatment group ( p < 0.001). Perfusion rate could be improved to 90 +/- 2% compared to 83 +/- 5% in the untreated group (p < 0.01). Systemic arterial blood pressure was not affected by administration of the receptor antagonist., Conclusion: These data indicate that the endothelin receptor antagonist treatment results in prevention of postischemic sinusoidal constriction. Perfusion rate could be improved due to dilation of sinusoids and diminished leukocyte adhesion, but leukocyte velocity was reduced by 31%.

Aim: The pathogenesis of the ischemia-/reperfusion injury after liver transplantation is not fully understood. The purpose of this study was to analyse blood flow and vascular resistance of the hepatic artery and the portal vein after long ischemic time., Methods: A model of orthotopic liver transplantation in pigs was used. Two groups with different cold ischemic times (CIT) were formed: group A: short ischemic time (4-6 hrs CIT), 7 transplantations/group B: long ischemic time (20-24 hrs CIT), 7 transplantations. The blood flow was measured by means of electromagnetic technique. The intravascular pressure was determined in the aorta, portal vein and hepatic vein after direct punction or by inserted catheters., Results: After short ischemic time and 1 hour of reperfusion a decrease of the arterial and portal venous resistance was observed, while the total hepatic blood flow remained constant. Six hours after reperfusion the arterial and portal venous vascular resistance increased and reached almost values of the donor animal. However, marked changes of hemodynamic parameters were found after long ischemic time, especially in the portal venous vascular system. The vascular resistance of the portal vein was significantly elevated and reached values ten-times higher than during the donor operation., Conclusion: The decrease of the vascular resistance during the early reperfusion period was surprising because of the well-known results of histological studies and analysis of the microcirculation. The cause remained unknown, but an increased perfusion via intrahepatic shunts or denervation of the transplant may be responsible for this observation. The elevated portal venous resistance after severe ischemic damage most likely reflected the increase of interstitial pressure. In the clinic monitoring of the portal venous vascular system by means of doppler-sonography may be an useful adjunct in the diagnosis of early postoperative transplant-dysfunction.

The article presents a study which examines different techniques for the reduction of normothermic hepatic ischaemia-reperfusion (IR) injury risk. An overview of the methodology used for the study is provided, along with information on the causes and treatment of IR injury. Surgical approaches can impact several aspects of IR injury, while pharmacological techniques frequently show little impact. There are pharmacological approaches that revealed promising outcome with enhanced clinical outcome.

A response by H. U. Spiegel and R. Bahde to a letter to the editor about their article "Hepatic Ischaemia-Reperfusion Injury From Bench to Bedside" in the 2010 issue is presented.

Cytoprotective proteins are highly involved in cellular injury and regeneration, apoptosis and inflammation in the setting of solid organ transplantation. In renal transplants, expression of protective proteins is demonstrable in the early ischemia/reperfusion phase. The aim of the study was to investigate the effects of the cytoprotective protein heme oxygenase-1 (HO-1) induced by the substance hemin in the setting of isogeneic renal transplantation. Thirty-five isogeneic male Lewis rats (200-250 g) were divided into three groups. In group I and II researchers performed total nephrectomy following orthotopic kidney transplantation.