Maitane I Orue-Echebarria1,2, Javier Vaquero3, Cristina J Lisbona4, Pablo Lozano1, Miguel A Steiner1, Álvaro Morales1, José Á López-Baena1, Juan Laso4, Inmaculada Hernández4, Luis Olmedilla4, José L García Sabrido1, Isabel Peligros5, Emma Sola5, Carlos Carballal6, Elena Vara7, J M Asencio8,9,10. 1. Transplant and Hepatobiliopancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain. 2. Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. 3. Research Laboratory in Hepatology and Gastroenterology, Hospital General Universitario Gregorio Marañón - IiSGM - CIBERehd, Madrid, Spain. 4. Department of Anaesthesiology and Resuscitation, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain. 5. Department of Pathology, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain. 6. Department of Neurosurgery, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain. 7. Department of Biochemistry and Molecular Biology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. 8. Transplant and Hepatobiliopancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain. jmasencio@gmail.com. 9. Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. jmasencio@gmail.com. 10. Department of General Surgery, Hospital General Universitario Gregorio Marañón - IiSGM, c/ Doctor Esquerdo 46, 28007, Madrid, Spain. jmasencio@gmail.com.
Abstract
INTRODUCTION: The term "Small-for-Flow" reflects the pathogenetic relevance of hepatic hemodynamics for the "Small-For-Size" syndrome and posthepatectomy liver failure. We aimed to characterize a large-animal model for studying the "Small-for-Flow" syndrome. METHODS: We performed subtotal (90%) hepatectomies in 10 female MiniPigs using a simplified transection technique with a tourniquet. Blood tests, hepatic and systemic hemodynamics, and hepatic function and histology were assessed before (Bas), 15 min (t-15 min) and 24 h (t-24 h) after the operation. Some pigs underwent computed tomography (CT) scans for hepatic volumetry (n = 4) and intracranial pressure (ICP) monitoring (n = 3). Postoperative care was performed in an intensive care unit environment. RESULTS: All hepatectomies were successfully performed, and hepatic volumetry confirmed liver remnant volumes of 9.2% [6.2-11.2]. The hepatectomy resulted in characteristic hepatic hemodynamic alterations, including portal hyperperfusion, relative decrease of hepatic arterial blood flow, and increased portal pressure (PP) and portal-systemic pressure gradient. The model reproduced major diagnostic features including the development of cholestasis, coagulopathy, encephalopathy with increased ICP, ascites, and renal failure, hyperdynamic circulation, and hyperlactatemia. Two animals (20%) died before t-24 h. Histological liver damage was observed at t-15 min and at t-24 h. The degree of histological damage at t-24 h correlated with intraoperative PP (r = 0.689, p = 0.028), hepatic arterial blood flow (r = 0.655, p = 0.040), and hepatic arterial pulsatility index (r = 0.724, p = 0.066). All animals with intraoperative PP > 20 mmHg presented liver damage at t-24 h. CONCLUSION: The present 90% hepatectomy porcine experimental model is a feasible and reproducible model for investigating the "Small-for-Flow" syndrome.
INTRODUCTION: The term "Small-for-Flow" reflects the pathogenetic relevance of hepatic hemodynamics for the "Small-For-Size" syndrome and posthepatectomy liver failure. We aimed to characterize a large-animal model for studying the "Small-for-Flow" syndrome. METHODS: We performed subtotal (90%) hepatectomies in 10 female MiniPigs using a simplified transection technique with a tourniquet. Blood tests, hepatic and systemic hemodynamics, and hepatic function and histology were assessed before (Bas), 15 min (t-15 min) and 24 h (t-24 h) after the operation. Some pigs underwent computed tomography (CT) scans for hepatic volumetry (n = 4) and intracranial pressure (ICP) monitoring (n = 3). Postoperative care was performed in an intensive care unit environment. RESULTS: All hepatectomies were successfully performed, and hepatic volumetry confirmed liver remnant volumes of 9.2% [6.2-11.2]. The hepatectomy resulted in characteristic hepatic hemodynamic alterations, including portal hyperperfusion, relative decrease of hepatic arterial blood flow, and increased portal pressure (PP) and portal-systemic pressure gradient. The model reproduced major diagnostic features including the development of cholestasis, coagulopathy, encephalopathy with increased ICP, ascites, and renal failure, hyperdynamic circulation, and hyperlactatemia. Two animals (20%) died before t-24 h. Histological liver damage was observed at t-15 min and at t-24 h. The degree of histological damage at t-24 h correlated with intraoperative PP (r = 0.689, p = 0.028), hepatic arterial blood flow (r = 0.655, p = 0.040), and hepatic arterial pulsatility index (r = 0.724, p = 0.066). All animals with intraoperative PP > 20 mmHg presented liver damage at t-24 h. CONCLUSION: The present 90% hepatectomy porcine experimental model is a feasible and reproducible model for investigating the "Small-for-Flow" syndrome.
Authors: F G Court; S A Wemyss-Holden; C P Morrison; B D Teague; P E Laws; J Kew; A R Dennison; G J Maddern Journal: Br J Surg Date: 2003-04 Impact factor: 6.939