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Galvao FHF, Araki J, Fonseca ABS, Cruz RJ, Lanchotte C, Waisberg DR, Chaib E, Nacif LS, Traldi MCDC, de Mello EB, Andraus W, Carneiro-D'Albuquerque L. Multivisceral transplantation of pelvic organs in rats. Front Surg 2023; 10:1086651. [PMID: 37151860 PMCID: PMC10159176 DOI: 10.3389/fsurg.2023.1086651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/15/2023] [Indexed: 05/09/2023] Open
Abstract
Background Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats. Donor operation We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed en bloc, flushed, and cold-stored. Recipient operation The infrarenal aorta and vena cava were isolated and donor/recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery. Results We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation. Conclusion The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.
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Affiliation(s)
- Flavio Henrique Ferreira Galvao
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Correspondence: Flavio Henrique Ferreira Galvao Av. Dr. Arnaldo 433, sala 3210. Sao Paulo-SP, Brazil. 01246-903
| | - Jun Araki
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ana Bruna Salles Fonseca
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ruy Jorge Cruz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cinthia Lanchotte
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eleazar Chaib
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Souto Nacif
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Clara de Camargo Traldi
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Estrella Bianco de Mello
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellington Andraus
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Carneiro-D'Albuquerque
- Laboratory of Medical Investigation 37, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Araki J, Nishizawa Y, Fujita N, Sato T, Lizuka T, Komata M, Hatayama N, Yakura T, Hirai S, Tashiro K, Galvão FHF, Nakamura T, Nakagawa M, Naito M. Anorectal Transplantation: The First Long-term Success in a Canine Model. Ann Surg 2022; 275:e636-e644. [PMID: 33491981 PMCID: PMC8906251 DOI: 10.1097/sla.0000000000004141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function. SUMMARY BACKGROUND DATA We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation. METHODS In the pudendal nerve function study, 6 dogs were randomly divided into 2 groups, transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination. In the anorectal transplantation model, 4 dogs were assigned to 4 groups: autotransplant, allotransplant with immunosuppression, allotransplant without immunosuppression, and normal control. Long-term function was evaluated by defecography, videography, and histological examination. RESULTS In the pudendal nerve function study, anorectal manometry indicated that the anastomosis group recovered partial function 6 months postoperatively. Microscopically, the pudendal nerve and the sphincter muscle regenerated in the anastomosis group. Anorectal transplantation was technically successful with a 3-stage operation: colostomy preparation, anorectal transplantation, and stoma closure. The dog who underwent allotransplantation and immunosuppression had 2 episodes of mild rejection, which were reversed with methylprednisolone and tacrolimus. The dog who underwent allotransplantation without immunosuppression had a severe acute rejection that resulted in graft necrosis. Successful dogs had full defecation control at the end of the study. CONCLUSIONS We describe the critical role of the pudendal nerve in anorectal function and the first long-term success with anorectal transplantation in a canine model. This report is a proof-of-concept study for anorectal transplantation as a treatment for patients with an ostomy because of anorectal dysfunction.
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Affiliation(s)
- Jun Araki
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoki Fujita
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, Japan
| | | | - Tomoya Lizuka
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Komata
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, Japan
| | | | - Tomiko Yakura
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Shuichi Hirai
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Kensuke Tashiro
- Department of Plastic and Reconstructive Surgery, Juntendo University, Tokyo, Japan
| | - Flavio H F Galvão
- Laboratory of Liver Transplantation and Experimental Surgery (LIM-37), Division of Liver Transplantation, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Masahiro Nakagawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, Aichi, Japan
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Galvão FHF, Waisberg DR, Seid VE, Costa ACL, Chaib E, Baptista RR, Capelozzi VL, Lanchotte C, Cruz RJ, Araki J, D'Albuquerque LC. Allogeneic anorectal transplantation in rats: technical considerations and preliminary results. Sci Rep 2016; 6:30894. [PMID: 27488366 PMCID: PMC4973224 DOI: 10.1038/srep30894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/11/2016] [Indexed: 01/24/2023] Open
Abstract
Fecal incontinence is a challenging condition with numerous available treatment modalities. Success rates vary across these modalities, and permanent colostomy is often indicated when they fail. For these cases, a novel potential therapeutic strategy is anorectal transplantation (ATx). We performed four isogeneic (Lewis-to-Lewis) and seven allogeneic (Wistar-to-Lewis) ATx procedures. The anorectum was retrieved with a vascular pedicle containing the aorta in continuity with the inferior mesenteric artery and portal vein in continuity with the inferior mesenteric vein. In the recipient, the native anorectal segment was removed and the graft was transplanted by end-to-side aorta-aorta and porto-cava anastomoses and end-to-end colorectal anastomosis. Recipients were sacrificed at the experimental endpoint on postoperative day 30. Surviving animals resumed normal body weight gain and clinical performance within 5 days of surgery. Isografts and 42.9% of allografts achieved normal clinical evolution up to the experimental endpoint. In 57.1% of allografts, signs of immunological rejection (abdominal distention, diarrhea, and anal mucosa inflammation) were observed three weeks after transplantation. Histology revealed moderate to severe rejection in allografts and no signs of rejection in isografts. We describe a feasible model of ATx in rats, which may allow further physiological and immunologic studies.
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Affiliation(s)
- Flavio H F Galvão
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Daniel R Waisberg
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Victor E Seid
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Eleazar Chaib
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Rachel Rossini Baptista
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Cinthia Lanchotte
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ruy J Cruz
- Intestinal Rehabilitation and Transplant Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jun Araki
- Department of Plastic Surgery, University of Tokyo, Tokyo, Japan
| | - Luiz Carneiro D'Albuquerque
- Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Ferreira Galvao F, Araki J, Seid V, Waisberg D, Traldi M, Naito M, Araujo B, Lanchotte C, Chaib E, D'Albuquerque L. Evidence That Anorectal Transplantation Is the Logical Treatment for Serious Anorectal Dysfunction and Permanent Colostomy. Transplant Proc 2016; 48:497-8. [PMID: 27109986 DOI: 10.1016/j.transproceed.2015.10.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 10/21/2022]
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Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach. Sci Rep 2014; 4:6312. [PMID: 25204282 PMCID: PMC4159625 DOI: 10.1038/srep06312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022] Open
Abstract
Colostomy is conventional treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published as a potential alternative to colostomies; however, further development of this technique is required. In this study, we utilized a canine model of anorectal transplantation, evaluated the patency of our microsurgical anastomoses, and assessed the perfusion of the transplanted anus. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed in four healthy beagle dogs by anastomoses of the lower rectum, the bilateral pudendal arteries (PAs) and veins (PVs), and pudendal nerves (PNs). Postoperative graft perfusion was measured by indocyanine green (ICG) angiography and histological examination. The length of the anorectal graft including perianal skin, anal sphincter muscle, bilateral PAs, PVs, and PNs was 4.9 ± 0.3 cm. All diameters of the PAs, PVs, and PNs were large enough to be microscopically anastomosed. Both ICG angiography and histological examination demonstrated good graft perfusion, except for one case that lead to venous congestion. These results show that anastomosis of the bilateral PAs, PVs, and PNs is required for anorectal transplantation. This is the first successful report of canine anorectal autotransplantation.
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