Liver regeneration during the associating liver partition and portal vein ligation for staged hepatectomy procedure in Sus�scrofa is positively modulated by stem cells

Abstract

This present study investigated the impact of the application of stem cells to liver regeneration following the first stage of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The experiment was conducted on a pig model (n=6, 3 that did not receive application of stem cells, 3 that received application stem cells). Collected samples of liver (day 0 and 9 following surgery) were subjected to complete transcriptome sequencing. In total, 39 differentially expressed genes were found in the group without the application of the stem cells (genes of unwanted processes such as fibrosis and inflammation). In the group that did receive application of stem cells, no significantly differentially expressed genes were found, indicating a properly regenerated liver remnant. The present study therefore demonstrated, to the best of our knowledge for the first time, the positive effect of stem cells application in the liver regeneration process during ALPPS procedure in the pig model.

Surgical Models of Liver Regeneration in Pigs: A Practical Review of the Literature for Researchers

“…Four articles considered ALPPS [44,46,47,55]. The interval time between the first and the second stage ranged from 5 days [46] to 9 days [44]. Deal et al performed PVL, ALPPS, and "partial ALPPS" by varying degrees of parenchymal transection, demonstrating that liver hypertrophy following PVL increased following the increasing of transected parenchyma, with an inverse proportion to developing collaterals [47].…”

“…Thirty-six studies (88% of all articles) considered hepatic resections, of which 32 were about direct hepatectomy and 4 were ALPPS [44,46,47,55]. The highest RLV was 60% of the primitive liver volume [56,61], while the lowest was 10% [38,49,52,64] (Table 2).…”

“…Among the ALPPS models, only Croome et al [55] performed an extended-left hepatectomy with a described RLV of 15-20%. The remaining three ALPPS authors [44,46,47] reported the type of resection (left hepatectomy) without quantification of RLV, and this also happened in 10 studies concerning direct hepatectomy [30,32,33,36,41,44,46,47,66,68]. Only two studies considered a hepatotoxic pre-treatment using retrorsine [42] or carbon tetrachloride (CCl4) and alcohol [56].…”

“…Only two studies considered a hepatotoxic pre-treatment using retrorsine [42] or carbon tetrachloride (CCl4) and alcohol [56]. Regarding the PH, sixteen experiments studied liver regeneration in response to liver resection without any additional procedures, while 20 studies evaluated how the liver regenerative capacity was influenced by SCA [30][31][32]39,41,44,51,[66][67][68], IRI [30,32,39,41,53,61,63,66], PVM [34,45,48,58], PVE [49], liver scaffold application [31,33], bio-artificial liver treatment [43], and application of terlipressin and octreotide [64,65]. The caudate lobe was always preserved.…”

“…Schadde et al [40] tried to evaluate how the portal vein occlusion could improve the RLV when associated with hepatic vein ligation, finding an advantage in liver regeneration for the ladder technique and was the only one who studied the effect of vein ligation without performing a PH. Four articles considered ALPPS [44,46,47,55]. The interval time between the first and the second stage ranged from 5 days [46] to 9 days [44].…”