A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia

<p>Abstract</p> <p>Background</p> <p>Advances in intensive care support such as therapeutic hypothermia or new liver assist devices have been the mainstay of treatment attempting to bridge the gap from acute liver failure to liver transplantation, but the efficacy of th...

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Main Authors: Königsrainer Alfred, Morgalla Matthias H, Schenk Thomas, Etspüler Alexander, Schenk Martin, Thiel Karolin, Thiel Christian
Format: Article
Language:English
Published: BMC 2011-07-01
Series:BMC Gastroenterology
Online Access:http://www.biomedcentral.com/1471-230X/11/79
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spelling doaj-ec2c79180dfa4f95bf80da08cae998272020-11-25T01:38:55ZengBMCBMC Gastroenterology1471-230X2011-07-011117910.1186/1471-230X-11-79A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermiaKönigsrainer AlfredMorgalla Matthias HSchenk ThomasEtspüler AlexanderSchenk MartinThiel KarolinThiel Christian<p>Abstract</p> <p>Background</p> <p>Advances in intensive care support such as therapeutic hypothermia or new liver assist devices have been the mainstay of treatment attempting to bridge the gap from acute liver failure to liver transplantation, but the efficacy of the available devices in reducing mortality has been questioned. To address this issue, the present animal study was aimed to analyze the pure clinical effects of a simple extracorporeal dummy device in an anhepatic porcine model of acute liver failure.</p> <p>Methods</p> <p>Total hepatectomy was performed in ten female pigs followed by standardized intensive care support until death. Five animals (dummy group, n = 5) underwent additional cyclic connection to an extracorporeal dummy device which consisted of a plasma separation unit. The separated undetoxified plasma was completely returned to the pigs circulation without any plasma substitution or exchange in contrast to animals receiving intensive care support alone (control group, n = 5). All physiological parameters such as vital and ventilation parameters were monitored electronically; laboratory values and endotoxin levels were measured every 8 hours.</p> <p>Results</p> <p>Survival of the dummy device group was 74 ± 6 hours in contrast to 53 ± 5 hours of the control group which was statistically significant (p < 0.05). Body temperature 24 hours after hepatectomy was significantly lower (36.5 ± 0.5°C vs. 38.2 ± 0.7°C) in the dummy device group. Significant lower values were measured for blood lactate (1.9 ± 0.2 vs. 2.5 ± 0.5 mM/L) from 16 hours, creatinine (1.5 ± 0.2 vs. 2.0 ± 0.3 mg/dL) from 40 hours and ammonia (273 ± 122 vs. 1345 ± 700 μg/dL) from 48 hours after hepatectomy until death. A significant rise of endotoxin levels indicated the onset of sepsis at time of death in 60% (3/5) of the dummy device group animals surviving beyond 60 hours from hepatectomy.</p> <p>Conclusions</p> <p>Episodes of slight hypothermia induced by cyclic connection to the extracorporeal dummy device produced a significant survival benefit of more than 20 hours through organ protection and hemodynamic stabilisation. Animal studies which focus on a survival benefit generated by liver assist devices should especially address the aspect of slight transient hypothermia by extracorporeal cooling.</p> http://www.biomedcentral.com/1471-230X/11/79
collection DOAJ
language English
format Article
sources DOAJ
author Königsrainer Alfred
Morgalla Matthias H
Schenk Thomas
Etspüler Alexander
Schenk Martin
Thiel Karolin
Thiel Christian
spellingShingle Königsrainer Alfred
Morgalla Matthias H
Schenk Thomas
Etspüler Alexander
Schenk Martin
Thiel Karolin
Thiel Christian
A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
BMC Gastroenterology
author_facet Königsrainer Alfred
Morgalla Matthias H
Schenk Thomas
Etspüler Alexander
Schenk Martin
Thiel Karolin
Thiel Christian
author_sort Königsrainer Alfred
title A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
title_short A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
title_full A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
title_fullStr A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
title_full_unstemmed A simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
title_sort simple dummy liver assist device prolongs anhepatic survival in a porcine model of total hepatectomy by slight hypothermia
publisher BMC
series BMC Gastroenterology
issn 1471-230X
publishDate 2011-07-01
description <p>Abstract</p> <p>Background</p> <p>Advances in intensive care support such as therapeutic hypothermia or new liver assist devices have been the mainstay of treatment attempting to bridge the gap from acute liver failure to liver transplantation, but the efficacy of the available devices in reducing mortality has been questioned. To address this issue, the present animal study was aimed to analyze the pure clinical effects of a simple extracorporeal dummy device in an anhepatic porcine model of acute liver failure.</p> <p>Methods</p> <p>Total hepatectomy was performed in ten female pigs followed by standardized intensive care support until death. Five animals (dummy group, n = 5) underwent additional cyclic connection to an extracorporeal dummy device which consisted of a plasma separation unit. The separated undetoxified plasma was completely returned to the pigs circulation without any plasma substitution or exchange in contrast to animals receiving intensive care support alone (control group, n = 5). All physiological parameters such as vital and ventilation parameters were monitored electronically; laboratory values and endotoxin levels were measured every 8 hours.</p> <p>Results</p> <p>Survival of the dummy device group was 74 ± 6 hours in contrast to 53 ± 5 hours of the control group which was statistically significant (p < 0.05). Body temperature 24 hours after hepatectomy was significantly lower (36.5 ± 0.5°C vs. 38.2 ± 0.7°C) in the dummy device group. Significant lower values were measured for blood lactate (1.9 ± 0.2 vs. 2.5 ± 0.5 mM/L) from 16 hours, creatinine (1.5 ± 0.2 vs. 2.0 ± 0.3 mg/dL) from 40 hours and ammonia (273 ± 122 vs. 1345 ± 700 μg/dL) from 48 hours after hepatectomy until death. A significant rise of endotoxin levels indicated the onset of sepsis at time of death in 60% (3/5) of the dummy device group animals surviving beyond 60 hours from hepatectomy.</p> <p>Conclusions</p> <p>Episodes of slight hypothermia induced by cyclic connection to the extracorporeal dummy device produced a significant survival benefit of more than 20 hours through organ protection and hemodynamic stabilisation. Animal studies which focus on a survival benefit generated by liver assist devices should especially address the aspect of slight transient hypothermia by extracorporeal cooling.</p>
url http://www.biomedcentral.com/1471-230X/11/79
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