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Zhang Y, He X, Ma P, Xiong L, Bai W, Zhang G, Xu Y, Song W, Yu K. Establishment of a Rat Model of Liver Venous Deprivation: Simultaneous Portal and Hepatic Vein Ligation. J Clin Transl Hepatol 2023; 11:393-404. [PMID: 36643043 PMCID: PMC9817047 DOI: 10.14218/jcth.2022.00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIMS The aim was to establish a liver venous deprivation (LVD) model in rats, compare hepatic hypertrophy between LVD and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS), and explore the underlying mechanisms. METHODS The LVD or extended-LVD (e-LVD) group received portal vein ligation (PVL) combined with hepatic vein ligation (HVL). The ALPPS or e-ALPPS group received PVL plus parenchyma ligation. Liver regeneration was assessed by measuring the liver weight and performing pathological analysis. Liver functions and the sphingosine kinase 1 (SPHK1)/sphingosine-1-phosphate (S1P)/sphingosine-1-phosphate receptor 1 (S1PR1) pathway were also investigated. RESULTS All future liver remnants (FLRs) in the ALPPS, e-ALPPS, LVD, and e-LVD groups exhibited significant hypertrophy compared with the control group. The LVD and e-LVD procedures induced similar liver hypertrophy than that in the corresponding ALPPS groups. Furthermore, the LVD and e-LVD methods led to obvious cytolysis in the venous-deprived lobes as well as a noticeable increase in serum transaminase levels, while no necrosis was observed in the ALPPS and e-ALPPS groups. SPHK1/S1P/S1PR1 pathway were distinctly activated after operation, especially in congestive/ischemic livers. CONCLUSIONS We describe the first rat model of LVD and e-LVD with simultaneously associated HVL and PVL. Compared with the ALPPS technique, the LVD or e-LVD procedure had a comparable overall effect on the hypertrophy response and a stronger effect on liver function. The SPHK1/S1P/S1PR1 pathway was involved in the LVD- or ALPPS-induced liver remodeling.
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Affiliation(s)
- Yuefeng Zhang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoqin He
- Department of Teaching Office, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Peng Ma
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liangkun Xiong
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenhui Bai
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gaoshuo Zhang
- Department of Teaching Office, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yangtao Xu
- The First Clinical College, Wuhan University, Wuhan, Hubei, China
| | - Wei Song
- The First Clinical College, Wuhan University, Wuhan, Hubei, China
| | - Kaihuan Yu
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Correspondence to: Kaihuan Yu, Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China. ORCID: https://orcid.org/0000-0001-9235-7848. Tel: +86-13517282628, E-mail:
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Böning G, Fehrenbach U, Auer TA, Neumann K, Jonczyk M, Pratschke J, Schöning W, Schmelzle M, Gebauer B. Liver Venous Deprivation (LVD) Versus Portal Vein Embolization (PVE) Alone Prior to Extended Hepatectomy: A Matched Pair Analysis. Cardiovasc Intervent Radiol 2022; 45:950-957. [PMID: 35314879 PMCID: PMC9226084 DOI: 10.1007/s00270-022-03107-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate whether liver venous deprivation (LVD) as simultaneous, portal vein (PVE) and right hepatic vein embolization offers advantages in terms of hypertrophy induction before extended hepatectomy in non-cirrhotic liver. MATERIALS AND METHODS Between June 2018 and August 2019, 20 patients were recruited for a prospective, non-randomized study to investigate the efficacy of LVD. After screening of 134 patients treated using PVE alone from January 2015 to August 2019, 14 directly matched pairs regarding tumor entity (cholangiocarcinoma, CC and colorectal carcinoma, CRC) and hypertrophy time (defined as time from embolization to follow-up imaging) were identified. In both treatment groups, the same experienced reader (> 5 years experience) performed imaging-based measurement of the volumes of liver segments of the future liver remnant (FLR) prior to embolization and after the standard clinical hypertrophy interval (~ 30 days), before surgery. Percentage growth of segments was calculated and compared. RESULTS After matched follow-up periods (mean of 30.5 days), there were no statistically significant differences in relative hypertrophy of FLRs. Mean ± standard deviation relative hypertrophy rates for LVD/PVE were 59 ± 29.6%/54.1 ± 27.6% (p = 0.637) for segments II + III and 48.2 ± 22.2%/44.9 ± 28.9% (p = 0.719) for segments II-IV, respectively. CONCLUSIONS LVD had no significant advantages over the standard method (PVE alone) in terms of hypertrophy induction of the FLR before extended hepatectomy in this study population.
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Affiliation(s)
- Georg Böning
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Jonczyk
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Combined biembolization induces higher hypertrophy than portal vein embolization before major liver resection. HPB (Oxford) 2020; 22:298-305. [PMID: 31481315 DOI: 10.1016/j.hpb.2019.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/29/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Combined preoperative portal and hepatic vein embolization (biembolization, BE) has been recently described and may further enhance preoperative FLR growth. The objective of this study was to compare the efficacy of combined preoperative biembolization and portal vein embolization (PVE). METHODS This study was performed between 2010 and 2017. From 2010 to 2014, patients only underwent preoperative PVE. After 2014, BE was proposed as an alternative to PVE. Liver volumetry was assessed by a CT-scan before BE or PVE and then three weeks later. RESULTS During the study period, 72 patients underwent radiological procedures that included 41 PVE (PVE group) and 31 BE (BE group). The time elapsing between the procedure and surgery was similar (p = 0.760). The mean percentage of FLR ratio hypertrophy in the PVE group was 31.9% (±34), but reached 51.2% (±42) in the BE group (p = 0.018) and this difference remained significant under multivariate analysis that included age, gender, body mass index, diabetes mellitus, cirrhosis and NASH. The kinetic growth rates were 19% (±17%) and 8% (±13%) in the BE and PVE groups, respectively (p = 0.026). CONCLUSION This study shows that BE induces higher hypertrophy than portal vein embolization before major liver resection with no more morbidity.
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Kawaguchi Y, Lillemoe HA, Vauthey JN. Dealing with an insufficient future liver remnant: Portal vein embolization and two-stage hepatectomy. J Surg Oncol 2019; 119:594-603. [PMID: 30825223 DOI: 10.1002/jso.25430] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 12/18/2022]
Abstract
Colorectal liver metastases (CLM) are not always resectable at the time of diagnosis. An insufficient future liver remnant is a factor excluding patients from curative intent resection. To deal with this issue, two-stage hepatectomy was introduced approximately 20 years ago. It is a sequential treatment strategy for bilateral CLM, which consists of preoperative chemotherapy, portal vein embolization, and planned first and second liver resections. This study reviews current evidence supporting use of two-stage hepatectomy.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Schadde E, Guiu B, Deal R, Kalil J, Arslan B, Tasse J, Olthof PB, Heil J, Schnitzbauer AA, Jakate S, Breitenstein S, Schläpfer M, Beck Schimmer B, Hertl M. Simultaneous hepatic and portal vein ligation induces rapid liver hypertrophy: A study in pigs. Surgery 2019; 165:525-533. [PMID: 30482517 DOI: 10.1016/j.surg.2018.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by adding simultaneous parenchymal transection ("ALPPS procedure"). This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal collaterals without need for operative transection. METHODS A pig model of portal vein occlusion was compared with the novel model of simultaneous portal and hepatic vein occlusion, where major hepatic veins draining the portal vein-deprived lobe were identified with intraoperative ultrasonography and ligated using pledgeted transparenchymal sutures. Kinetic growth was compared, and the portal vein system was then studied after 7 days using epoxy casts of the portal circulation. Portal vein flow and portal pressure were measured, and Ki-67 staining was used to evaluate the proliferative response. RESULTS Pigs were randomly assigned to portal vein occlusion (n = 8) or simultaneous portal and hepatic vein occlusion (n = 6). Simultaneous portal and hepatic vein occlusion was well tolerated and led to mild cytolysis, with no necrosis in the outflow vein-deprived liver sectors. The portal vein-supplied sector increased by 90 ± 22% (mean ± standard deviation) after simultaneous portal and hepatic vein occlusion compared with 29 ± 18% after PVL (P < .001). Collaterals to the deportalized liver developed after 7 days in both procedures but were markedly reduced in simultaneous portal and hepatic vein occlusion. Ki-67 staining at 7 days was comparable. CONCLUSION This study in pigs found that simultaneous portal and hepatic vein occlusion led to rapid hypertrophy without necrosis of the deportalized liver. The findings suggest that the use of simultaneous portal and hepatic vein occlusion accelerates liver hypertrophy for extended liver resections and should be evaluated further.
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Affiliation(s)
- Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland; Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland.
| | - Boris Guiu
- Department of Radiology, St. Eloi University Hospital, Montpellier, France
| | - Rebecca Deal
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Jennifer Kalil
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Bulent Arslan
- Department of Radiology, Interventional Radiology, Rush University Medical Center, Chicago, IL
| | - Jordan Tasse
- Department of Radiology, Interventional Radiology, Rush University Medical Center, Chicago, IL
| | - Pim B Olthof
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Heil
- Department of Surgery, Johann Wolfgang Goethe University Medical Center, Frankfurt, Germany
| | - Andreas A Schnitzbauer
- Department of Surgery, Johann Wolfgang Goethe University Medical Center, Frankfurt, Germany
| | - Shriram Jakate
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | | | - Martin Schläpfer
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Martin Hertl
- Department of Surgery, Rush University Medical Center, Chicago, IL
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Le Roy B, Perrey A, Fontarensky M, Gagnière J, Abergel A, Pereira B, Lambert C, Boyer L, Pezet D, Chabrot P, Buc E. Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report. World J Surg 2017; 41:1848-1856. [DOI: 10.1007/s00268-017-4016-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Comparable liver function and volume increase after portal vein embolization in rabbits and humans. Surgery 2017; 161:658-665. [DOI: 10.1016/j.surg.2016.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/13/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022]
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Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol 2016; 26:4259-4267. [DOI: 10.1007/s00330-016-4291-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 02/06/2023]
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Sánchez-Velázquez P, Castellví Q, Villanueva A, Quesada R, Pañella C, Cáceres M, Dorcaratto D, Andaluz A, Moll X, Trujillo M, Burdío JM, Berjano E, Grande L, Ivorra A, Burdío F. Irreversible electroporation of the liver: is there a safe limit to the ablation volume? Sci Rep 2016; 6:23781. [PMID: 27032535 PMCID: PMC4817133 DOI: 10.1038/srep23781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/14/2016] [Indexed: 02/08/2023] Open
Abstract
Irreversible electroporation is a fast-growing liver ablation technique. Although safety has been well documented in small ablations, our aim is to assess its safety and feasibility when a large portion of liver is ablated. Eighty-seven mice were subjected to high voltage pulses directly delivered across parallel plate electrodes comprising around 40% of mouse liver. One group consisted in 55 athymic-nude, in which a tumor from the KM12C cell line was grown and the other thirty-two C57-Bl6 non-tumoral mice. Both groups were subsequently divided into subsets according to the delivered field strength (1000 V/cm, 2000 V/cm) and whether or not they received anti-hyperkalemia therapy. Early mortality (less than 24 hours post-IRE) in the 2000 V/cm group was observed and revealed considerably higher mean potassium levels. In contrast, the animals subjected to a 2000 V/cm field treated with the anti-hyperkalemia therapy had higher survival rates (OR = 0.1, 95%CI = 0.02–0.32, p < 0.001). Early mortality also depended on the electric field magnitude of the IRE protocol, as mice given 1000 V/cm survived longer than those given 2000 V/cm (OR = 4.7, 95%CI = 1.8–11.8, p = 0.001). Our findings suggest that ionic disturbances, mainly due to potassium alterations, should be warned and envisioned when large volume ablations are performed by IRE.
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Affiliation(s)
- P Sánchez-Velázquez
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Q Castellví
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Carrer Roc Boronat 138, 08018, Barcelona, Spain
| | - A Villanueva
- Translational Research Laboratory, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av. de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Quesada
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - C Pañella
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - M Cáceres
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - D Dorcaratto
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - A Andaluz
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona (U.A.B), Plaza Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - X Moll
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona (U.A.B), Plaza Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - M Trujillo
- Electronic Engineering Department, Universitat Politècnica de Valencia, Camino de Vera, 46022 Valencia, Spain
| | - J M Burdío
- Department of Electric Engineering and Communications, University of Zaragoza, Pedro Cerbuna, 12, 50018 Zaragoza, Spain
| | - E Berjano
- Electronic Engineering Department, Universitat Politècnica de Valencia, Camino de Vera, 46022 Valencia, Spain
| | - L Grande
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - A Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Carrer Roc Boronat 138, 08018, Barcelona, Spain
| | - F Burdío
- Department of Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Passeig Marítim 25-29, 08003, Barcelona, Spain
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A review of animal models for portal vein embolization. J Surg Res 2014; 191:179-88. [PMID: 25017706 DOI: 10.1016/j.jss.2014.05.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 03/19/2014] [Accepted: 05/30/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Portal vein embolization (PVE) is a preoperative intervention to increase the future remnant liver (FRL) through regeneration of the non-embolized liver lobes. This review assesses all the relevant animal models of PVE available, to guide researchers who intend to study PVE. MATERIALS AND METHODS We performed a systematic literature search in Medline and Pubmed, from 1993-June 2013, using search headings "PVE" and "portal vein ligation". Articles were included when meeting the selection criteria: experimental animal study on PVE or portal vein ligation and experiments described in 5 animals or more. RESULTS Sixty-one articles were selected, describing six different animal models. Most articles reported experiments with rats, rabbits, and pigs. In rats, the increase in wet-weight ratio of the non-occluded liver or total liver weight is greatest in the first 7 d with values ranging from 75%-80.5% on day 7. The volume increase of FRL in the rabbit model is greatest in the first 7 d with values ranging from 33.6%-80% on day 7. In pigs, the largest gain in volume of the FRL was seen in the first 2 wk. CONCLUSIONS The choice of the model depends on the specific aim of the study. Evaluating the increase in liver volume and liver function after PVE, larger animals as the pig, rabbit, or the dog is useful because of the possibility to apply computed tomography volumetry. To evaluate mechanisms of regeneration after PVE, the rat model is useful, because of the variety of antibodies commercially available.
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Current world literature. Curr Opin Organ Transplant 2013; 18:241-50. [PMID: 23486386 DOI: 10.1097/mot.0b013e32835f5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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