title: A reproducible, clinically relevant, intensively managed, pig model of acute liver failure for testing of therapies aimed to prolong survival.
abstract: BACKGROUND
  A clinically relevant, translational large animal model of acute liver failure (ALF) is required for testing of novel therapies to prolong survival in acute liver failure, to permit spontaneous liver recovery or to act as a bridge to transplantation.
  
  
  OBJECTIVE
  The aim was to establish a pig model of acetaminophen-induced ALF that mimics the human clinical syndrome, is managed as in a human intensive care unit and has a predictable survival time.
  
  
  METHODS
  Nine female pigs were anaesthetised and instrumented for continuous intensive care monitoring and management using: target-driven protocols for treatment of cardiovascular collapse, metabolic acidosis and electrolyte abnormalities; intermittent positive pressure ventilation; and continuous renal replacement therapy. Six animals were induced to ALF with acetaminophen (paracetamol). Three animals acted as controls.
  
  
  RESULTS
  Irreversible acute liver failure, defined as rise in prothrombin time >3 times normal, occurred 19.3 ± 1.8 h after the onset of acetaminophen administration. Death occurred predictably 12.6 ± 2.7 h thereafter, with acute hepatocellular necrosis in all animals. Clinical progression of liver failure mimicked the human condition including development of coagulopathy, intracranial hypertension, hyperammonaemia, cardiovascular collapse, elevation in creatinine, metabolic acidosis and hyperlactataemia. In addition, cardiovascular monitoring clearly demonstrated progressive cardiac dysfunction in ALF.
  
  
  CONCLUSIONS
  A reproducible, clinically relevant, intensively managed, large animal model of acute liver failure, with death as a result of multi-organ failure, has been successfully validated for translational studies of disease progression and therapies designed to prolong survival in man.
authors: Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, UK. klee@rvc.ac.uk
authors: Karla C L
authors: KC
authors: Lee
authors: Carolina
authors: C
authors: Palacios Jimenez
authors: Hatim
authors: H
authors: Alibhai
authors: Yu-Mei
authors: YM
authors: Chang
authors: Pamela J
authors: PJ
authors: Leckie
authors: Luisa A
authors: LA
authors: Baker
authors: Giacomo
authors: G
authors: Stanzani
authors: Simon
authors: S
authors: L Priestnall
authors: Rajeshwar P
authors: RP
authors: Mookerjee
authors: Rajiv
authors: R
authors: Jalan
authors: Nathan A
authors: NA
authors: Davies
mesh_terms: D000082:Acetaminophen; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D004195:Disease Models, Animal; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D007427:Intracranial Pressure; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D017114:Liver Failure, Acute / Q000097:blood / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008991:Monitoring, Physiologic; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009336:Necrosis; D017582:Renal Replacement Therapy; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D013552:Swine; D013997:Time Factors
chemical_list: D015415:Biomarkers; D000082:Acetaminophen