Abstract
A252 Aims: Acute hepatic failure is a dramatic clinical syndrome that is associated with significant mortality despite advances in intensive care management and liver transplantation. Aim of this study was to evaluate treatment efficiency of maximum conventional intensive care therapy in a new pig model which is clinical relevant to simulate the situation of acute liver failure. Methods: Ten pigs underwent a total hepatectomy using a three-way prosthesis for reconstruction of the vena cava/vena portae continuity without any temporary extracorporal bypass. Blood loss was substituted with porcine erythrocyte concentrates and fresh frozen plasma. Posthepatectomy pigs were maintained under general anaesthesia and treated with noradrenalin, furosemide, hydroxyethylstarch 6%, sodiumchloride 0.9% glucose 20% under standard intensive care conditions. Electrocardiogram, direct blood pressure, urinary output, SO2 oximetry, core body temperature, lactate, blood gases and serum electrolytes, glucose were continuously monitored, Ammonia and liver depending clotting factors were measured every 12 hours. Death was defined as a decline of blood pressure under 40 mmHg. Results: Hemodynamic parameters remained stable during operation time, survival time was 36-89 hours (median 66h). All animals developed MOF, especially kidney and lung. Ammonia and lactate levels remained under forced diuresis at a level of 220 μg/dl and 5 mM, at time of death, levels of 4000 μg/dl and 16 mM were reached. Activity of liver depending clotting factors went down linear. Conclusions: This animal model with a conventional intensive care allows a long survival of the animals, even longer than most therapy studies with bioartificial liver devices.
Published Version
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