A surgical model of fulminant hepatic failure in the rabbit: different effects of end-to-side versus small-diameter side-to-side portacaval shunt.

We developed a rabbit model of fulminant hepatic failure by way of a two-staged total liver devascularisation procedure. For the first-stage procedure (portosystemic shunting), the clinical, biochemical and electro-encephalographic courses in 6 rabbits (group I) with an end-to-side portacaval shunt (ETS-PCS), 6 rabbits (group II) with a small-diameter side-to-side portacaval shunt (STS-PCS) and 6 rabbits (group III) with the same STS-PCS and 48 h of pretreatment with oxytetracycline were investigated and compared to 6 sham rabbits (group IV). The limited survival, the fall in clotting factors and the rapid development of hyperammonaemia with encephalopathy within 48 h in group I point to ETS-PCS-associated ischaemic liver necrosis. Group II showed improved survival, but was associated with portosystemic encephalopathy. Rabbits in group III survived portosystemic surgery without development of marked encephalopathy. In all animals of group III, the second-stage procedure (tightening of the loose ligature around the afferent hepatic vessels) could be performed, and a suitable model of fulminant hepatic failure was obtained.