Effects of air embolism size and location on porcine hepatic microcirculation in machine perfusion

UMMS Affiliation

Department of Surgery, University of Massachusetts Memorial Medical Center

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Hepatology | Surgery


The handling of donor organs frequently introduces air into the microvasculature, but little is known about the extent of the damage caused as a function of the embolism size and distribution. Here we introduced embolisms of different sizes into the portal vein, the hepatic artery, or both during the flushing stage of porcine liver procurement. The outcomes were evaluated during 3 hours of machine perfusion and were compared to the outcomes of livers with no embolisms. Dynamic contrast-enhanced ultrasound (DCEUS) was used to assess the perfusion quality, and it demonstrated that embolisms tended to flow mostly into the left lobe, occasionally into the right lobe, and rarely into the caudate lobe. Major embolisms could disrupt the flow entirely, whereas minor embolisms resulted in reduced or heterogeneous flow. Embolisms occasionally migrated to different regions of the same lobe and, regardless of their size, caused a general deterioration in the flow over time. Histological damage resulted primarily when both vessels of the liver were compromised, whereas bile production was diminished in livers that had arterial embolisms. Air embolisms produced a dose-dependent increase in vascular resistance and a decline in oxygen consumption. This is the first article to quantify the impact of air embolisms on microcirculation in an experimental model, and it demonstrates that air embolisms have the capacity to degrade the integrity of donor organs. The extent of organ damage is strongly dependent on the size and distribution of air embolisms. The diagnosis of embolism severity can be safely and easily made with DCEUS.

DOI of Published Version



Liver Transpl. 2014 May;20(5):601-11. doi: 10.1002/lt.23838. Link to article on publisher's site

Journal/Book/Conference Title

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

Related Resources

Link to Article in PubMed

PubMed ID