Original Article
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 28, 2014; 20(4): 1021-1029
Published online Jan 28, 2014. doi: 10.3748/wjg.v20.i4.1021
Portal inflow preservation during portal diversion in small-for-size syndrome
Xian-Qiang Wang, Yue-Fang Xu, Jing-Wang Tan, Wen-Ping Lv, Zhe Liu, Jian-Ping Zeng, Jia-Hong Dong
Xian-Qiang Wang, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, China
Xian-Qiang Wang, Wen-Ping Lv, Zhe Liu, Jian-Ping Zeng, Jia-Hong Dong, Department of Hepatobiliary Surgery, the Chinese PLA General Hospital, Beijing 100853, China
Yue-Fang Xu, Department of Pharmacology, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing 100048, China
Jing-Wang Tan, Department of Hepatobiliary Surgery, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing 100048, China
Author contributions: Wang XQ and Dong JH conceived and designed the experiments; Wang XQ, Tan JW and Xu YF performed the experiments; Lv WP, Liu Z and Zeng JP analyzed the data; Wang XQ and Tan JW wrote the paper; all the authors have read and approved the final manuscript to be published.
Supported by Chinese Ministry of Health, China, No. 200802012, the Project of National Natural Science Foundation of China, No. 81271738; and the National Science and Technology Major Project, No. 2012BAI06B01
Correspondence to: Jia-Hong Dong, MD, PhD, FACS, Department of Hepatobiliary Surgery, the Chinese PLA General Hospital, Beijing, China. dongjh_301@163.com
Telephone: +86-10-66938030 Fax: +86-10-66848636
Received: April 3, 2013
Revised: July 23, 2013
Accepted: September 4, 2013
Published online: January 28, 2014
Processing time: 297 Days and 20.6 Hours
Abstract

AIM: To investigate the impact of portal inflow on liver remnants in a stable pig model of small-for-size syndrome.

METHODS: Twenty pigs underwent mesocaval shunt (MCS) surgery followed by 85%-90% hepatectomy. The control group had no shunt placement; the S1 group had portal flow maintained at an average of 2.0 times the baseline values; and the S2 group had portal flow maintained at an average of 3.2 times the baseline flow. The effect of portal functional competition on the liver remnant was investigated for 48 h postoperatively. Data were presented as mean ± SD. Statistical significance was determined using Student’s t test (SPSS, Chicago, IL, United States). Values of P < 0.05 were considered statistically significant.

RESULTS: At 24 h after hepatectomy, biochemical and histological changes were not significantly different between the S1 and S2 groups, but changes in both sets of variables were significantly less than in the control group. At 48 h, biochemical and histological changes were significantly less in the S2 group than in the S1 or control group. The regeneration index was significantly higher in the S2 group than in the S1 group, and was similar to that in the control group. Apoptosis index, serum lipopolysaccharide, and bacterial DNA levels were significantly lower in the S2 group than in the other two groups.

CONCLUSION: Diversion of portal inflow using MCS reduces portal overflow injury. Excessive diversion of portal inflow inhibits liver regeneration following major hepatectomy. Maintaining portal inflow at an average of 3.2 times above baseline helps promote hypertrophy of the liver remnant and reduce apoptosis.

Keywords: Portal flow; Portal diversion; Small-for-size syndrome; Mesocaval shunt

Core tip: We established a model of small-for-size syndrome in pigs undergoing 85%-90% hepatectomy with mesocaval shunt (MCS) placement to define the optimal portal inflow required to preserve liver regeneration. Our findings indicate that diversion of portal inflow by MCS reduces injury from portal overflow following major hepatectomy, whereas excessive diversion of portal flow can retard liver regeneration. Preservation of portal inflow to at least 3.2 times above baseline levels appeared to promote hepatocyte hypertrophy and reduce apoptosis.