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



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.


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.


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.


The present 90% hepatectomy porcine experimental model is a feasible and reproducible model for investigating the “Small-for-Flow” syndrome.

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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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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

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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).

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  • Small-for-Size
  • Hepatectomy
  • Pig
  • Small-For-Flow
  • Posthepatectomy liver failure