Porcine models for the study of small‐for‐size syndrome and portal inflow modulation: literature review and proposal for a standardized nomenclature

Abstract

Porcine models of extended hepatectomy and liver transplantation (LT) of reduced graft have been widely used for studying the small-for-size (SFS) syndrome and the various modalities of portal inflow modulation (PIM). However, considerable heterogeneity exists among the studies and their results. The aim of this review was to assess the main advantages and drawbacks of the different porcine models of SFS LT and SFS hepatectomy, and propose a standardized anatomical nomenclature for the various models. The MEDLINE database was searched for articles reporting porcine models of reduced graft LT or hepatectomy of more than 65%. Nineteen articles on SFS LT matched our inclusion criteria, including 10 articles reporting a model of PIM. Twenty-seven articles reporting a model of posthepatectomy SFS were identified, of which 16 reported a model of PIM. Subtotal hepatectomy (i.e. resection of all segments except segment 1) without inflow occlusion, left trisectionectomy with inflow occlusion, and LT of a right lateral section including the caudate lobe in a larger recipient appeared to be the most suitable porcine models for studying the SFS syndrome. All three models were appropriate for assessing the surgical and pharmaceutical PIM modalities, except for those involving the splenic flow.

Porcine models for the study of small‐for‐size syndrome

“…Furthermore, we disagree with the statement of Mohkam et al. that splenic artery ligation and splenectomy are not appropriate for portal inflow modulation in swine. The authors report it was recently demonstrated that neither splenic artery ligation, nor splenectomy had any effect on portal venous flow in animals undergoing left trisectionectomy or subtotal hepatectomy; however, there is no publication from Mohkam et al.…”

“…We read with great interest the recent publication by Mohkam et al. published in the November 2016 issue of the Journal of Hepato‐Biliary‐Pancreatic Sciences . The authors describe the porcine models that have been used for the study of small‐for‐size syndrome (SFSS) after liver transplantation (LT) or extended hepatectomy and also the various modalities of portal inflow modulation (PIM).…”

Surgical Training and Simulation of Split‐Liver Transplantation in an Ex Vivo Porcine Model

“…The porcine liver is macroscopically divided into 4 lobes, but segmentation of the liver is still subjected to differing interpretations. (4,5) Văn Minh reported that the LLL, LML, and RML in porcine livers correspond with segments 2, 3, and 4/5/8 in humans, respectively. (4) On the other hand, Mohkam et al reported that LLL, LML, and RML in porcine livers correspond with segments 2/3, 4, and 5/8 in humans, respectively.…”

“…(4) On the other hand, Mohkam et al reported that LLL, LML, and RML in porcine livers correspond with segments 2/3, 4, and 5/8 in humans, respectively. (5) Understanding the segmentation of the liver is important for surgical training for SLT because the split between an extended right lobe and a left lateral segment can be achieved. In this study, we noted that there is a round ligament of the liver between the LML and RML (Fig.…”

Small‐for‐size syndrome in live donor liver transplantation—Pathways of injury and therapeutic strategies

“…Recently, Mohkam et al . have reviewed different techniques of portal inflow modulation on porcine models for the treatment of SFSS.…”