Animal models of Associating Liver Partition and Portal veinLigation for Staged hepatectomy (ALPPS)

Abstract

Background: In the recent years many animal models of ALPPS were introduced. These are important to developpatient safety and understand its background physiology. Our aim was to compare and assess the animal models developed by our research group. Methods: Wistar rats, sheep and swine were used. The rats underwent portal vein ligation (PVL) including the branches feeding the right and left lateral, right medial and caudal lobes,the liver was partitioned according to the falciform ligament. In swine, the PVL included the left lateral and medial lobes (55-60% of the liver) and medial part of the medial lobe, the right lateral lobe (20-24% of the liver) was partially resected. Medial lobe was transected in the midline. In sheep, the left branch of the portal vein was ligated and the liver was partitioned alongside the gallbladder’s bed, 20% remnant livervolume (RLV) was reached by the partial resection of the right lobe. Results: Using rats and pigs results in less accurate ALPPS models, as their livers need “humanization” by series of PVLs because of the lobular build and short on interlobular porto-portal anastomoses. The sheep liver is the most human-like in its proportions and vascular anatomy, and can be split with ease, unfortunately the animal’s extrahepatic anatomy statesdisturbances. Conclusion: Rat models are suited for basic research, withpoor translational capability. Large animal models have more translational potential, but currently no suitable one exists.