Effect of the Portacaval Shunt on Reperfusion Injury after 65% Hepatectomy in Pigs

Abstract

Background: Portal flow diversion by portacaval shunts (PCS) has been shown to prevent primary graft nonfunction in liver transplantation using small-for-size grafts. In this study, we examine whether PCS can improve reperfusion injury after major hepatectomy in pigs. Materials and Methods: In 14 pigs, a partial PCS was constructed following 65% hepatectomy and 1 h of inflow ischemia. During 24 h of reperfusion, the shunt was either closed (group A, n = 7) or left open (group B, n = 7). Results: 24 h after reperfusion, group A had higher levels of alanine aminotransferase (70 ± 12 IU/l vs. 51 ± 5.9 IU/l; p < 0.05), alanine aminotransferase per gram of liver remnant (0.41 ± 0.07 IU/l/g vs. 0.21 ± 0.05 IU/l/g; p < 0.05), prothrombin time (24.1 ± 2.4 s vs. 14.3 ± 2.9 s; p < 0.05), international normalized ratio (2.11 ± 0.15 vs. 1.29 ± 0.28; p < 0.05), hepatocyte necrosis scores and percentages of nuclei stained for proliferating cell nuclear antigen (52.57 ± 8.9% vs. 36.71 ± 6%; p < 0.05) compared to group B. Conclusions: Partial portal flow diversion appears to attenuate reperfusion injury in a porcine model of major hepatectomy.

A Pre-Clinical Large Animal Model of Sustained Liver Injury and Regeneration Stimulus

“…Hematoxylin-eosin (H & E) staining demonstrated mixed small and large hepatocyte nuclei, and accumulations of fatty globules in hepatocytes following PH; this anisokaryosis and simultaneous fatty degeneration indicates both regenerative and degenerative changes in the hepatocytes 25 , 26 . These effects were detected 10 and 17 days after PH in RS-treated animals, while they were already present after only 3 days in controls (Fig.…”

“…5c–e ). To gain further insights into the regenerative response in pigs exposed to RS, we next quantified the proliferating cell nuclear antigen (PCNA) and Ki-67 expression 25 , 27 , 28 . The number of PCNA-positive cells was significantly higher in RS-treated animals than controls at PH.…”

“…Histological findings also demonstrated that the regenerative responses of RS-treated animals were suppressed 3 days after PH. Although it is difficult to distinguish regenerative reactions from degenerative changes of liver tissues morphologically (because these changes are frequently seen simultaneously), the presence of anisokaryosis and binucleated hepatocytes suggested regenerative responses as well as the expected fatty degeneration 25 , 26 . Immunohistochemistry data supported the hypothesis that RS-treatment suppressed the cell cycle and delayed liver regeneration.…”

Small Liver Remnants Are More Vulnerable to Ischemia/Reperfusion Injury after Extended Hepatectomies: A Case–Control Study

“…Similarly, it has been suggested that after extensive hepatectomies, a small liver remnant is vulnerable to functional impairment, probably induced by the enforced diversion of the entire portal flow through a restricted sinusoidal network and the resulting shear stress and congestion of the sinusoidal endothelial lining cells [12][13][14].…”