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Comprehensive Characterization of a Porcine Model of The “Small-for-Flow” Syndrome

  • Original Article
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Journal of Gastrointestinal Surgery

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.

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Funding

This study is supported by a grant of the Sociedad Española de Trasplante Hepático (SETH) to J.M.A. J.V. was supported by a grant from ISCIII-Fondos FEDER “Una manera de hacer Europa” (PI15/1083) from Spain.

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Authors and Affiliations

  1. Transplant and Hepatobiliopancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain

    Maitane I. Orue-Echebarria, Pablo Lozano, Miguel A. Steiner, Álvaro Morales, José Á. López-Baena, José L. García Sabrido & J. M. Asencio

  2. Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    Maitane I. Orue-Echebarria & J. M. Asencio

  3. Research Laboratory in Hepatology and Gastroenterology, Hospital General Universitario Gregorio Marañón - IiSGM – CIBERehd, Madrid, Spain

    Javier Vaquero

  4. Department of Anaesthesiology and Resuscitation, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain

    Cristina J. Lisbona, Juan Laso, Inmaculada Hernández & Luis Olmedilla

  5. Department of Pathology, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain

    Isabel Peligros & Emma Sola

  6. Department of Neurosurgery, Hospital General Universitario Gregorio Marañón - IiSGM, Madrid, Spain

    Carlos Carballal

  7. Department of Biochemistry and Molecular Biology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    Elena Vara

  8. Department of General Surgery, Hospital General Universitario Gregorio Marañón - IiSGM, c/ Doctor Esquerdo 46, 28007, Madrid, Spain

    J. M. Asencio

Authors
  1. Maitane I. Orue-Echebarria
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  2. Javier Vaquero
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  3. Cristina J. Lisbona
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  4. Pablo Lozano
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  8. Juan Laso
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  9. Inmaculada Hernández
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  11. José L. García Sabrido
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  12. Isabel Peligros
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  13. Emma Sola
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  14. Carlos Carballal
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  15. Elena Vara
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  16. J. M. Asencio
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Contributions

Acquisition of data and drafting the work and final approval and agreement to be accountable for the work: Pablo Lozano, Miguel A. Steiner, Álvaro Morales, Juan Laso, Inma Hernández, Isabel Peligros, Emma Sola, Carlos Carballal, Elena Vara

Acquisition, analysis, and interpretation of data and drafting and revising and final approval and agreement to be accountable for the work: Maitane I. Orue-Echebarria, Javier Vaquero, Cristina J. Lisbona

Conception, design, acquisition, analysis, and interpretation and revising and final approval and agreement to be accountable for the work: José M. Asencio, Jose Á. López-Baena, José L. García Sabrido, Luis Olmedilla

Corresponding author

Correspondence to J. M. Asencio.

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Orue-Echebarria, M.I., Vaquero, J., Lisbona, C.J. et al. Comprehensive Characterization of a Porcine Model of The “Small-for-Flow” Syndrome. J Gastrointest Surg 23, 2174–2183 (2019). https://doi.org/10.1007/s11605-019-04130-2

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  • DOI: https://doi.org/10.1007/s11605-019-04130-2

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