In this research, the effects of portocaval shunt plus 70% partial hepatectomy were evaluated in 11 pigs. Hepatic coma and death from progressive liver failure occurred in 5 pigs between 14 and 64 h from surgery, whereas 3 pigs, which also showed symptoms of progressive liver failure, died of presumed gastric hemorrhage between 17 and 19 h after surgery. In 3 pigs, transient liver failure was followed by complete recovery, as judged by clinical, electroencephalographic and biochemical parameters. No case of death occurred among the pigs treated with portocaval shunt alone or 70% partial hepatectomy alone as controls. This new model for acute liver failure is reproducible, seems to be potentially reversible, causes death due to hepatic failure after a time period sufficiently long to allow for the institution of support procedures, is applied to a large animal and lacks relevant biohazard. Therefore, this model may be used to evaluate possible support procedures during acute liver failure.
The coagulation-fibrinolysis system and platelet function were studied in two patients with fulminant hepatic failure undergoing charcoal hemoperfusion with prostacyclin (PGI2) infusion. There was no adverse effect on the purely coagulative side and significant decreases were found only in Factors V and VII. There was a significant increase in platelet count and initially high BTG values decreased to normal. The findings suggest that PGI2 greatly improves the biocompatibility of hemoperfusion devices.
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