Review article
Assessment of the hepatic circulation in humans: New concepts based on evidence derived from a D-sorbitol clearance method

https://doi.org/10.1016/S0022-2143(98)90139-1Get rights and content

Abstract

d-Sorbitol (SOR) is safe, is easy to measure, and has an exceptionally high extraction ratio in the normal liver of 0.93 ± 0.05 (mean ± SD). Together with the general interest in hepatic hemodynamics, these facts motivated us to review the usefulness of this compound for the assessment of liver plasma flow in humans. We concluded that in subjects without liver disease the nonrenal clearance of SOR—measured noninvasively—very closely approximates hepatic plasma flow. Because of its lower and more variable extraction ratio, indocyanine green should no longer be used without hepatic vein catheterization. Even in patients with cirrhosis, SOR exhibits higher hepatic extraction ratios than indocyanine green. To fully explore the potential of SOR in the evaluation of such patients attention needs to be paid to the complex changes in architecture and function occurring in this disease. In cirrhotics the noninvasively measured nonrenal clearance of SOR presumably approximates the flow through intact and capillarized sinusoids (functional flow) and reflects the amount of blood having functional contact with hepatocytes. The theoretic background of the method, its accuracy, further research needs, and potentials of various approaches are discussed in detail.

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      Although ICG provides a good approximation of hepatic blood flow under normal physiologic states, it is not reliable in the presence of cirrhosis because its hepatic extraction is decreased.91 Other indicators with a higher and more predictable extraction ratio have been recently used to assess hepatic blood flow in the presence of cirrhosis.71 Even these indicators, however, show variable extraction ratios in the presence of cirrhosis.14

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