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Review article: the role of the microcirculation in liver cirrhosis

Davies, T; Wythe, S; O'Beirne, J; Martin, D; Gilbert-Kawai, E; (2017) Review article: the role of the microcirculation in liver cirrhosis. Alimentary Pharmacology and Therapeutics , 46 (9) pp. 825-835. 10.1111/apt.14279. Green open access

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Abstract

BACKGROUND: Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcirculation and the role this may have in the pathogenesis of multiple organ failure in end stage liver cirrhosis. AIM: To provide an update on the role of the microcirculation in the pathophysiology of cirrhosis and its associated complications and briefly discuss some of the imaging techniques which may be used to directly investigate the microcirculation. METHODS: A Medline literature search was conducted using the following search terms: ‘cirrhosis’, ‘microcirculation’, ‘circulation’, ‘systemic’, ‘inflammation’, ‘peripheral’, ‘hepatorenal’ and ‘hepatopulmonary’. RESULTS: Significant heterogeneous microvascular alterations exist in patients with cirrhosis. Data suggest that the systemic inflammation, associated with advanced cirrhosis, induces microcirculatory dysregulation and contributes to haemodynamic derangement. The resultant vasoconstriction and hypoperfusion in the systemic extrahepatic microvasculature, is likely to be instrumental in the pathophysiology of organ failure in decompensated cirrhosis, however the mechanistic action of vasoactive agents used to correct the circulatory disturbance of advanced cirrhosis is poorly understood. CONCLUSIONS: Further research into the role of the microcirculation in patients with liver cirrhosis, will improve physicians understanding of the pathophysiology of cirrhosis, and may provide a platform for real time evaluation of an individual's microcirculatory response to vasoactive mediators, thus guiding their therapy.

Type: Article
Title: Review article: the role of the microcirculation in liver cirrhosis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/apt.14279
Publisher version: http://dx.doi.org/10.1111/apt.14279
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: NEAR-INFRARED SPECTROSCOPY, ENDOTHELIAL GROWTH-FACTOR, PORTAL-HYPERTENSIVE-RATS, NITRIC-OXIDE SYNTHASE, PERIPHERAL ARTERIAL VASODILATION, CEREBRAL VASCULAR-RESISTANCE, FUNCTIONAL RENAL-FAILURE, HEPATIC STELLATE CELLS, NECROSIS-FACTOR-ALPHA, ACUTE KIDNEY INJURY
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10030722
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