Liver Regeneration Following Portacaval Transposition in Dogs

The ECK fistula in animals and humans

“…By replacing the diverted splanchnic venous blood with an inflow from the inferior vena cava to the hepatic end of the portal vein (Fig 4), Child et al avoided most of the adverse effects of Eck's fistula. These studies 24 and those of Fisher and his associates 25,26 gave firm support to the concept that the quality of portal venous inflow was not a prime determinant of hepatic structure, function, or the capacity for regeneration. In some of Fisher's experiments involving end points of regeneration, the diverted portal blood was replaced by arterializing the hilar portal stump.…”

“…In contrast, the studies by Child et al, 24 using portacaval transposition in dogs as the experimental model, were erroneously but generally interpreted as crucial evidence favoring the flow hypothesis and disproving the hepatotrophic concept. By replacing the diverted splanchnic venous blood with an inflow from the inferior vena cava to the hepatic end of the portal vein (Fig 4), Child et al avoided most of the adverse effects of Eck's fistula.…”

“…25 Subsequent workers accepted that the quantity of total hepatic blood flow was the main consideration in supporting liver health. This acceptance was maintained in spite of the demonstration that canine livers after venous transposition actually showed centrilobular atrophy, 24 and major deglycogenation, 27, 28 and thus were not in fact normal. The concensus favoring the flow hypothesis was an uneasy one, and in 1961 Bollman, one of Mann's younger associates, wrote, "In the 83 years since it was first reported the Eck fistula has been reasonably successful in hiding its secrets as well as giving rise to many additional questions fundamental to an understanding of the functions of the intestine, liver and brain.…”

“…The atrophy of the auxiliary organ was rapid and extreme (Fig 6), even though the blood supply was analogous to that in Child's portacaval transposition. 24 One possible explanation advanced was that the animal's own liver, in situ, which was perfused first by splanchnic venous blood, was extracting a disproportionate share of unspecified hepatotrophic substances and that the auxiliary organ atrophied because of its disadvantaged competitive situation. 30 The hypothesis was supported by Marchioro and his associates, 32 who showed that transplant atrophy could be prevented by diverting the nonhepatic splanchnic venous blood away from the host liver and through the graft.…”

Liver, Biliary Tract and Pancreas

“…(lll) If a preliminary Eck fistula is constructed, the capacity for regeneration is retarded. (32,114) If subtotal hepatectomy is then performed in dogs (114), a state of chronic hepatic insufficiency can be achieved.…”