A new technique for total hepatectomy in the pig for testing liver support devices.
BACKGROUND
A large animal model of total hepatectomy is suitable to test the efficacy of any system designed to support patients in hepatic coma. The models previously described in the pig entail a significant degree of surgical trauma, which might alter the evolution of the ensuring hepatic failure and compromise the reproducibility of the model.


METHODS
Twenty-eight pigs underwent a total hepatectomy according to a new technique. A model was considered satisfactory when it required no blood transfusions and when hematologic and hemodynamic parameters determined before, during, and until 4 hours after hepatectomy showed no significant variations. Moreover, to revive the pattern of hepatic coma produced in the anhepatic model, 7 pigs were monitored until brain death occurred.


RESULTS
Twenty-five pigs (89%) underwent a smooth total hepatectomy with minimal variations of the selected parameters. They constituted a highly homogeneous group. Survival of the 7 pigs, followed up until brain death occurred, ranged from 625 to 1595 minutes (mean 1013.57 minutes). The animals remained stable until a few hours before brain death, an event heralded by a final sharp increase of the serum ammonia level and by a well-evident decline of both arterial pressure and liver-dependent clotting factors.


CONCLUSIONS
This technique of total hepatectomy allows the construction of a reproducible model of anhepaty suitable to test the efficacy of any system conceived to temporarily replace hepatic functions.
Filipponi
F
F
Department of Oncology, University of Pisa, Italy.
Boggi
U
U
Meacci
L
L
Burchielli
S
S
Vistoli
F
F
Bellini
R
R
Prota
C
C
Colizzi
L
L
Kusmic
C
C
Campani
D
D
Gneri
C
C
Trivella
M G
MG
Mosca
F
F
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001926:Brain Death; D004195:Disease Models, Animal; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000601:surgery / Q000628:therapy; D007601:Jugular Veins / Q000601:surgery; D008099:Liver / Q000098:blood supply / Q000601:surgery; D017093:Liver Failure / Q000601:surgery* / Q000628:therapy*; D019164:Liver, Artificial; D011169:Portal Vein / Q000601:surgery; D013552:Swine; D014682:Vena Cava, Inferior / Q000601:surgery