Erschienen in:
07.02.2019 | Original Article
Comprehensive Characterization of a Porcine Model of The “Small-for-Flow” Syndrome
verfasst von:
Maitane I. Orue-Echebarria, Javier Vaquero, Cristina J. Lisbona, Pablo Lozano, Miguel A. Steiner, Álvaro Morales, José Á. López-Baena, Juan Laso, Inmaculada Hernández, Luis Olmedilla, José L. García Sabrido, Isabel Peligros, Emma Sola, Carlos Carballal, Elena Vara, J. M. Asencio
Erschienen in:
Journal of Gastrointestinal Surgery
|
Ausgabe 11/2019
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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.