Establishing a Porcine Model of Small for Size Syndrome following Liver Resection

<jats:p><jats:italic>Background.</jats:italic> Small for size syndrome (SFSS) is responsible for a high proportion of mortalities and morbidities following extended liver resection.<jats:italic> Aim.</jats:italic> The aim of this study was to establish a porcine model of SFSS.<jats:italic> Methods.</jats:italic> Twenty-four Landrace pigs underwent liver resection with a remnant liver volume of 50% (group A, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">8</mml:mn></mml:math>), 25% (group B, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">8</mml:mn></mml:math>), and 15% (group C, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">8</mml:mn></mml:math>). After resection, the animals were followed up for 8 days and clinical, laboratory, and histopathological outcomes were evaluated.<jats:italic> Results.</jats:italic> The survival rate was significantly lower in group C compared with the other groups (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>p</mml:mi><mml:mo><</mml:mo><mml:mn fontstyle="italic">0.001</mml:mn></mml:math>). The international normalized ratio, bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase levels increased shortly after surgery in groups B and C, but no change was observed in group A (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>p</mml:mi><mml:mo><</mml:mo><mml:mn fontstyle="italic">0.05</mml:mn></mml:math> for all analyses). The histopathological findings in group A were mainly mild mitoses, in group B severe mitoses and hepatocyte ballooning, moderate congestion, and hemorrhage, along with mild necrosis, and in group C extended tissue damage with severe necrosis, hemorrhage, and congestion.<jats:italic> Conclusions.</jats:italic> Combination of clinical, laboratory, and histopathological evaluations is needed to confirm the diagnosis of SFSS. 75% liver resection in porcine model results in SFSS. 85% liver resection causes irreversible liver failure.</jats:p>