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The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig

Hammond, John S.; Godtliebsen, Fred; Steigen, Sonja; Guha, I. Neil; Wyatt, Judy; Revhaug, Arthur; Lobo, Dileep N.; Mortensen, Kim E.

The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig Thumbnail


Authors

John S. Hammond

Fred Godtliebsen

Sonja Steigen

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NEIL GUHA neil.guha@nottingham.ac.uk
Professor of Hepatology

Judy Wyatt

Arthur Revhaug

DILEEP LOBO dileep.lobo@nottingham.ac.uk
Professor of Gastrointestinal Surgery

Kim E. Mortensen



Abstract

Liver failure is the major cause of death following liver resection. Post-resection portal venous pressure (PVP) predicts liver failure, is implicated in its pathogenesis and when PVP is reduced, rates of liver dysfunction decrease. The aim of this study was to characterize the hemodynamic, biochemical and histological changes induced by 80% hepatectomy in non-cirrhotic pigs and determine if terlipressin or direct portacaval shunting can modulate these effects.Pigs were randomized (n=8/group) to undergo 80% hepatectomy alone (control); terlipressin (2 mg bolus + 0.5-1 mg/h) + 80% hepatectomy; or portacaval shunt (PCS) + 80% hepatectomy, and were maintained under terminal anesthesia for 8 hours. The primary outcome was change in PVP. Secondary outcomes included portal venous flow (PVF), hepatic arterial flow (HAF), and biochemical and histological markers of liver injury. Hepatectomy increased PVP (9.3±0.4mm Hg pre-hepatectomy vs.13.0±0.8mm Hg post-hepatectomy, p less than 0.0001) and PVF/g liver (1.2±0.2 ml/min/g vs.6.0±0.6 ml/min/g, p less than 0.0001) and decreased HAF (70.8±5.0 ml/min vs.41.8±5.7 ml/min, p=0.002). Terlipressin and PCS reduced PVP (terlipressin = 10.4±0.8 mm Hg, p=0.046and PCS=8.3±1.2 mm Hg, p=0.025) and PVF (control=869.0±36.1 ml/min vs. terlipressin=565.6±25.7 ml/min, p less than0.0001 and PCS=488.4±106.4 ml/min, p=0.002) compared with control. Treatment with terlipressin increased HAF (73.2±11.3 ml/min) compared with control (40.3±6.3ml/min, p=0.026). The results of this study suggest that terlipressin and PCS may have a role in the prevention and treatment of post-resection liver failure.

Citation

Hammond, J. S., Godtliebsen, F., Steigen, S., Guha, I. N., Wyatt, J., Revhaug, A., …Mortensen, K. E. (2019). The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig. Clinical Science, 133(1), 153-166. https://doi.org/10.1042/CS20180858

Journal Article Type Article
Acceptance Date Dec 29, 2018
Online Publication Date Jan 15, 2019
Publication Date Jan 15, 2019
Deposit Date Jan 3, 2019
Publicly Available Date Jan 16, 2020
Journal Clinical Science
Print ISSN 0143-5221
Electronic ISSN 1470-8736
Publisher Portland Press
Peer Reviewed Peer Reviewed
Volume 133
Issue 1
Pages 153-166
DOI https://doi.org/10.1042/CS20180858
Keywords post-resection liver failure; terlipressin; portacaval shunt.
Public URL https://nottingham-repository.worktribe.com/output/1441025
Contract Date Jan 3, 2019

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