• Karla C L Lee, Carolina Palacios Jimenez, Hatim Alibhai, Yu-Mei Chang, Pamela J Leckie, Luisa A Baker, Giacomo Stanzani, Simon L Priestnall, Rajeshwar P Mookerjee, Rajiv Jalan, and Nathan A Davies.
• Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, UK. klee@rvc.ac.uk
• Liver Int. 2013 Apr 1;33(4):544-51.

BackgroundA clinically relevant, translational large animal model of acute liver failure (ALF) is required for testing of novel therapies to prolong survival in acute liver failure, to permit spontaneous liver recovery or to act as a bridge to transplantation.AimsThe aim was to establish a pig model of acetaminophen-induced ALF that mimics the human clinical syndrome, is managed as in a human intensive care unit and has a predictable survival time.MethodsNine female pigs were anaesthetised and instrumented for continuous intensive care monitoring and management using: target-driven protocols for treatment of cardiovascular collapse, metabolic acidosis and electrolyte abnormalities; intermittent positive pressure ventilation; and continuous renal replacement therapy. Six animals were induced to ALF with acetaminophen (paracetamol). Three animals acted as controls.ResultsIrreversible acute liver failure, defined as rise in prothrombin time >3 times normal, occurred 19.3 ± 1.8 h after the onset of acetaminophen administration. Death occurred predictably 12.6 ± 2.7 h thereafter, with acute hepatocellular necrosis in all animals. Clinical progression of liver failure mimicked the human condition including development of coagulopathy, intracranial hypertension, hyperammonaemia, cardiovascular collapse, elevation in creatinine, metabolic acidosis and hyperlactataemia. In addition, cardiovascular monitoring clearly demonstrated progressive cardiac dysfunction in ALF.ConclusionsA reproducible, clinically relevant, intensively managed, large animal model of acute liver failure, with death as a result of multi-organ failure, has been successfully validated for translational studies of disease progression and therapies designed to prolong survival in man.© 2012 John Wiley & Sons A/S.

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