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Nacif LS, Alvarez PSE, Pinheiro RS, Da Silva Neto AB, De Maria Rocha Fonseca G, Fernandes MR, Santos JPC, Ernani L, Rocha-Santos V, De Martino RB, Waisberg DR, Macedo RA, Ducatti L, Haddad L, Galvão FHF, Andraus W, Carneiro-D Albuquerque L. Experimental Clinical Model of Liver Transplantation in Large White Pigs Without Venovenous Bypass: Pre-, Intra-, and Maintenance Care. Transplant Proc 2022; 54:1357-1360. [PMID: 35717258 DOI: 10.1016/j.transproceed.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Liver transplantation in an animal model is challenging due to hemodynamics and intraoperative anesthetic care. Several models are described in the literature employing different techniques such as venovenous bypass or aortic cross-clamping to maintain hemodynamic stability, although few groups keep the animal alive in the postoperative period. This study aims to evaluate a liver transplantation clinical model in pigs without venovenous bypass or aortic cross-clamping. METHODS Male pigs weighing 20 to 35 kg underwent liver transplantation surgery without using venovenous bypass or aorta cross-clamping. Protocols were approved by the Animal Care and Use Committee of the University of São Paulo, Brazil. RESULTS Ten LTs were performed. Cold ischemia and warm ischemia were 119 ± 33.28 minutes and 26 ± 9.6 minutes, respectively. Hemodynamic changes were significantly higher after the postrevasculazation phase: heart rate (P < .001), medium arterial pressure (P < .001), and cardiac output (P = .03). Hypotension was treated with intravenous fluids and, in some cases, with vasoactive drugs especially during the post-reperfusion period. No animals died during the procedure and almost survival until the first postoperative day. Serum aspartate aminotransferase and lactate increased their values in the post-reperfusion phase. CONCLUSIONS Practice-based on laboratory animals improves surgical skills and the development of experimental models aimed at new advances in this field. Perfecting our technique on the swine model, we could move forward to create a small-for-size model, test new therapeutic strategies, and define the boundaries for safely performing an enlarged liver resection or a partial liver graft transplant.
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Affiliation(s)
- Lucas Souto Nacif
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Paola Sofia Espinoza Alvarez
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rafael Soares Pinheiro
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Amadeo Batista Da Silva Neto
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Giovana De Maria Rocha Fonseca
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Michel Ribeiro Fernandes
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Joao Paulo Costas Santos
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lucas Ernani
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo Bronze De Martino
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rubens Arantes Macedo
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luciana Haddad
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flávio Henrique Ferreira Galvão
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wellington Andraus
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz Carneiro-D Albuquerque
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Zhang Y, Pan Q, Cheng Y, Liu Y. Effects of SP600125 and hypothermic machine perfusion on livers donated after cardiac death in a pig allograft transplantation model. Eur J Med Res 2021; 26:15. [PMID: 33546770 PMCID: PMC7863371 DOI: 10.1186/s40001-020-00472-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) improves the quality of donor livers for transplantation, both in animal models and in clinical practice. Treatment with SP600125, an inhibitor of c-Jun N-terminal kinase (JNK), can suppress the JNK signaling pathway to alleviate donor liver ischemia-reperfusion injury (IRI). We performed the present study with the objective of exploring the protective effects exerted by a combination of HMP and SP600125 on liver xenograft viability for donation after cardiac death (DCD) in a porcine model. METHODS 54 adult BAMA mini-pigs were randomly assigned to 5 groups, including sham, cold storage for 4 h (CS 4 h), CS 4 h + SP600125, CS 2 h + HMP 2 h, and CS 2 h + HMP 2 h + SP600125 groups. Donor livers in the CS 4 h and CS 4 h + SP600125 groups were conventionally cold preserved for 4 h, whereas donor livers in the CS 2 h + HMP 2 h and CS 2 h + HMP 2 h + SP600125 groups were cold preserved for 2 h and then treated with HMP for 2 h. The preservation and perfusion solutions contained SP600125 (20 µM). Follow-up was conducted for 5 days after liver transplantation to compare the surgical outcomes by means of serological examination, pathological results, and survival rate. RESULTS The most satisfactory outcome after liver transplantation was observed in the CS 2 h + HMP 2 h + SP600125 group, which presented with minimal damage of donor livers during 5 days' follow-up. Additionally, serological examination, pathological results, and survival rate concurred in showing better results in the CS 2 h + HMP 2 h ± SP600125 group than in the CS 4 h ± SP600125 group. CONCLUSION HMP in combination with SP600125 has hepatoprotective properties and improves the quality and viability of porcine livers collected after DCD, thus improving prognosis after liver transplantation.
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Affiliation(s)
- Yijie Zhang
- Department of Organ Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China.,The Key Laboratory of Organ Transplantation of Liaoning Province, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Qi Pan
- Department of Organ Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China.,The Key Laboratory of Organ Transplantation of Liaoning Province, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Ying Cheng
- Department of Organ Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China.,The Key Laboratory of Organ Transplantation of Liaoning Province, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yongfeng Liu
- Department of Organ Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China. .,The Key Laboratory of Organ Transplantation of Liaoning Province, The First Affiliated Hospital of China Medical University, No. 155, Nanjing Street, Shenyang, 110001, Liaoning, People's Republic of China.
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Oldhafer F, Wittauer EM, Beetz O, Vondran FWR. Long-term Functional Maintenance of Exteriorized Portal Venous Catheters in a Porcine Animal Model. J Surg Res 2020; 251:187-194. [PMID: 32163793 DOI: 10.1016/j.jss.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 01/10/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal venous access for blood sampling, infusion therapy, and measurement of portal venous pressure is of special interest for experimental studies in surgery, pharmacology, and hepatology. Chronic animal models with continuous portal venous access are rare and especially thrombosis or clotting of permanent catheters is a frequent complication. Aim of this study was to establish a preclinical pig model with a permanent portal venous catheter (PVC). MATERIALS AND METHODS PVC implantation was performed in 21 LEWE mini pigs. The catheter was inserted in the distal part of the superior mesenteric vein and fixated with a tobacco-pouch suture. Animals were followed up for 4 wk, directly after implantation of the PVC. Blood gas analyses and portal venous pressures were recorded. Three different groups with continuous infusion via the catheters were defined: NaCl solution (2 mL/h) (group 1), NaCl solution (2 mL/h) + enoxaparin sodium injection (anti-Xa levels of 0.3-0.8 U/mL) (group 2) and heparinized NaCl (2 I.E./mL, 2 mL/h) (group 3). RESULTS All 21 PVC implantations were performed without any complications. Application of continuous perfusion with heparinized NaCl (group 3) enabled portal venous access for the entire experiment in 8 of 10 cases (mean of 23.7 d) without any signs of dysfunction. However, for use of NaCl alone or in combination with enoxaparin sodium, catheters were only functional for 6.8 d and 6.9 d, respectively. CONCLUSIONS Permanent portal venous access through PVC in mini pigs is achievable by continuous infusion of low-dose heparinized NaCl solution.
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Affiliation(s)
- Felix Oldhafer
- Department of General, Visceral and Transplant Surgery, ReMediES, Hannover Medical School, Hannover, Germany.
| | - Eva-Maria Wittauer
- Department of General, Visceral and Transplant Surgery, ReMediES, Hannover Medical School, Hannover, Germany
| | - Oliver Beetz
- Department of General, Visceral and Transplant Surgery, ReMediES, Hannover Medical School, Hannover, Germany
| | - Florian W R Vondran
- Department of General, Visceral and Transplant Surgery, ReMediES, Hannover Medical School, Hannover, Germany
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Golriz M, Abbasi S, Fathi P, Majlesara A, Brenner T, Mehrabi A. Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection? Am J Physiol Gastrointest Liver Physiol 2017. [PMID: 28642298 DOI: 10.1152/ajpgi.00110.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco2 values increased after 75% resection in the jugular vein. In contrast, arterial Po2 increased after every resection, whereas the venous Po2 decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco2 in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation.NEW & NOTEWORTHY This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.
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Affiliation(s)
- Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; and
| | - Sepehr Abbasi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; and
| | - Parham Fathi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; and
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; and
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; and
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Spetzler VN, Goldaracena N, Knaak JM, Louis KS, Selzner N, Selzner M. Technique of porcine liver procurement and orthotopic transplantation using an active porto-caval shunt. J Vis Exp 2015:e52055. [PMID: 25992583 PMCID: PMC4542501 DOI: 10.3791/52055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The success of liver transplantation has resulted in a dramatic organ shortage. Each year, a considerable number of patients on the liver transplantation waiting list die without receiving an organ transplant or are delisted due to disease progression. Even after a successful transplantation, rejection and side effects of immunosuppression remain major concerns for graft survival and patient morbidity. Experimental animal research has been essential to the success of liver transplantation and still plays a pivotal role in the development of clinical transplantation practice. In particular, the porcine orthotopic liver transplantation model (OLTx) is optimal for clinically oriented research for its close resemblance to human size, anatomy, and physiology. Decompression of intestinal congestion during the anhepatic phase of porcine OLTx is important to guarantee reliable animal survival. The use of an active porto-caval-jugular shunt achieves excellent intestinal decompression. The system can be used for short-term as well as long-term survival experiments. The following protocol contains all technical information for a stable and reproducible liver transplantation model in pigs including post-operative animal care.
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Affiliation(s)
- Vinzent N Spetzler
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Nicolas Goldaracena
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Jan M Knaak
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Kristine S Louis
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Nazia Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital
| | - Markus Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital;
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Chen Y, Xu F, Hu L, Liu C, Li J. Significance of postoperative changes in hemodynamics and biochemical indices in pediatric recipients of live-donor liver transplants. Transplant Proc 2014; 45:3320-4. [PMID: 24182810 DOI: 10.1016/j.transproceed.2013.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 01/09/2013] [Accepted: 04/23/2013] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the postoperative changes in hemodynamics and biochemical indices in pediatric recipients of live-donor liver transplants (LDLT). METHODS Hemodynamics and biochemical indices (coagulation function, electrolytes, kidney function, liver function, and blood analysis) were monitored on the day before and the 1st, 3rd, 5th, and 7th days after the procedure in 20 children who underwent LDLT from June 2006 to January 2009. RESULTS Compared with preoperative measurements, systolic and diastolic blood pressure and mean arterial pressure increased and prothrombin time was prolonged significantly during the first 7 days after LDLT (P < .05). Fibrinogen, platelet count, total protein, globulin, and blood magnesium decreased significantly (P < .05). Liver enzymes (aspartate transaminase [AST], alanine transaminase [ALT]) and blood sodium increased significantly; serum potassium and calcium declined on the first postoperative day (P < .05). On the 7th day, AST returned to nearly normal (P < .05) and ALT returned to the preoperative levels. Blood urea nitrogen fluctuated within the normal range (P < .05). Total and direct bilirubin decreased on the 1st day but returned to near normal levels on the 7th day (P <.001). CONCLUSIONS Our data demonstrated postoperative changes in hemodynamics, electrolytes, and biochemical indices in pediatric LDLT recipients. The changes in clotting factors and platelet count did not result in severe coagulation function disorder; kidney function was normal. Changes in liver enzymes and bilirubin compared with the preoperation indices were within the regulatory scope of liver and did not result in severe complications. These preliminary postoperative trends suggest that further prospective evaluation is needed.
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Affiliation(s)
- Y Chen
- Intensive Care Unit, Key Medical Laboratory of Pediatrics, Chongqing Health Bureau, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Brito MVH, Araújo MTFD, Cunha LCB, Oliveira AJBD, Rodrigues JB, Brito NB. Immediate graft histological assay, post pig's liver transplantation. Acta Cir Bras 2013; 28:678-82. [PMID: 24000062 DOI: 10.1590/s0102-86502013000900009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/19/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe the vascular and tissue histopathological changes in seven sequential experimental liver transplantations in pigs. METHODS Fourteen female pigs, Sus domesticus species, with body mass between 5 and 8 kg were utilized. After the end of all anastomoses of the graft implantation in the receptor, the animal was monitored for 30 minutes, and at its end one of the biopsies was collected for histological analysis. The histological criteria utilized were: lytic hepatocyte necrosis, density of septal and portal inflammatory infiltrated, sinusoidal congestion and hemorrhage. The analysis was performed separately for the portal region in zone 1, 2 and 3. RESULTS Among the structural changes undergone by the graft, those with greater frequency and intensity were vascular congestion and steatosis, which stood out in transplantations 5, 6 and 7. CONCLUSIONS The technique demonstrated vascular alterations represented by vasocongestion, edema and minimum inflammatory reaction. In relation to the parenchyma, was observed macrovacuolar pan-acinar steatosis, focal lytic and occasional hemorrhages, beyond the accumulation of hemosiderin in Kuppfer's cells.
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Chkhaidze Z, Khodeli N, Pilishvili O, Partsakhashvili D, Jangavadze M, Kordzaia D. New model of veno-venous bypass for management of anhepatic phase in experimental study on dogs. Transplant Proc 2013; 45:1734-8. [PMID: 23769034 DOI: 10.1016/j.transproceed.2012.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/30/2012] [Indexed: 02/05/2023]
Abstract
Blood is shunted from the inferior vena cava and portal vein to the superior vena caval system to prevent congestion in the lower parts of the body during the anhepatic phase (AP) of liver transplantation. It leads to overload in the superior vena caval system retarding cranial outflow due to a nonphysiological blood redistribution. To overcome this problem, we developed a new bypass in dogs: blood is shunted from the inferior (caudal) vena cava and portal vein to the suprahepatic inferior (caudal) vena cava. This model was compared with traditional one with or without a pump. Blood pressure and flow parameters were estimated during 3 hours of AP in four groups of four dogs each. The current study showed that a nontraditional scheme of venous bypass reduced circulatory complications during AP, especially in the cranial vena caval system, although a low rate of congestion remains in the caudal vena cava and portal vein systems. Whereas the same scheme using a pump effectively prevented congestion in all of the systems: cranial, caudal, and portal. We concluded that application of a nontraditional bypass scheme, providing venous blood return into suprahepatic part of caudal vena cava, can be considered to be a method of choice for experimental liver transplantation.
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Affiliation(s)
- Z Chkhaidze
- Department of Clinical Anatomy and Operative Surgery, A. Natishvili Institute of Morphology, I. Javakhishvili State University, Tbilisi, Georgia
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Partsakhashvili D, Chkhaidze Z, Khodeli N, Pilishvili O, Jangavadze M, Kordzaia D. Experimental liver autotransplantation with novel scheme of veno-venous bypass as a model of liver denervation and delymphatization. Transplant Proc 2013; 45:1739-42. [PMID: 23769035 DOI: 10.1016/j.transproceed.2012.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/30/2012] [Indexed: 02/05/2023]
Abstract
The impact of denervation and delymphatization (DD) on liver tissue remains a topic of major interest in liver transplantation, as the organ or its part continues to function well. Various chemical and/or surgical interventions have been developed to achieve in situ liver denervation and delymphatization, but it is evident that DD can be achieved only through "ectomia", ie, complete isolation of the organ from adjacent and connected structures. This Study describes a liver DD model based on a technique of autotransplantation (replantation), maximally preventing ischemia in the transplanted (replanted) graft and dyscirculatory complications in the recipient. Experiments were performed on eight male mongrel dogs. Venous reservoir and roller pumps were used in a forced nontraditional bypass scheme. Autotransplantation was performed by step-by-step dissection of the suprahepatic, infrahepatic, and portal structures, leading to DD, with subsequent recovery of the blood vessel and bile duct. DD was achieved successfully with stable hemodynamic parameters during all surgery periods. All animals survived. This model of liver autotransplantation lead to DD of the organ. It was characterized by hemodynamic stability of the liver as well as of the whole body at every stage of the surgery, proffering liver DD for experimental studies.
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Affiliation(s)
- D Partsakhashvili
- Department of Clinical Anatomy and Operative Surgerey, Faculty of Medicine, A. Natishvili Institute of Morphology, I. Jakakhishvili State University (TSU), Tbilisi, Georgia
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Liu J, Chen DF, Yang AG, Zhou S, Zou YX, Nie K, Li RR, Liu GX. Development of an improved pig model of piggyback liver transplantation with temporary portacaval shunting. Shijie Huaren Xiaohua Zazhi 2011; 19:832-835. [DOI: 10.11569/wcjd.v19.i8.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To improve the piggy-back orthotopic liver transplantation (PBOLT) technique in pigs and to enhance the survival rate of pigs after liver transplantation.
METHODS: Pigs were divided into control group and experimental group. The inferior caval vein was separated from the liver of recipients by curettage and aspiration using Peng's multifunctional operative dissector in the control group. Temporary portacaval shunting was added in the experimental group to reduce congestion in the portal system during anhepatic phase.
RESULTS: The PBOLT procedures were performed in eight pairs of pigs in both the control group and experimental group, with a success rate of 87.5% and 100%, respectively. There were significant differences in cold ischemia time (142.8 min ± 7.4 min vs 155.6 min ± 8.3 min, P = 0.006), anhepatic phase duration (25.8 min ± 1.3 min vs 36.3 min ± 1.0 min, P = 0.000), and operation time (264.1 min ± 9.5 min vs 277.3 min ± 8.6 min, P = 0.012) between the two groups though no significant difference was noted in mean bleeding volume (892.5 mL ± 113.9 mL vs 888.8 mL ± 93.7 mL, P = 0.94). The 1-, 2-, 3- and 4-day survival rates were 87.5% and 100%, 25% and 100%, 12.5% and 87.5%, and 0% and 87.5% in the control group and experimental group, respectively. On day 10 after PBOLT, 87.5% of pigs of the experimental group were still alive (P = 0.000).
CONCLUSION: PBOLT with temporary portacaval shunting can maintain hemodynamic stability and relieve congestion of the portal system in pigs during liver transplantation. Control of gastrointestinal congestion is key to the success of liver transplantation and can raise the survival rate of pigs after liver transplantation.
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Fondevila C, Hessheimer AJ, Flores E, Vendrell M, Muñoz J, Escobar B, Calatayud D, Taurá P, Fuster J, García-Valdecasas JC. Step-by-step guide for a simplified model of porcine orthotopic liver transplant. J Surg Res 2011; 167:e39-45. [PMID: 21324490 DOI: 10.1016/j.jss.2011.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/29/2010] [Accepted: 01/05/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Based on similar anatomy, physiology, and size to humans, pigs provide an excellent means for studying new therapies related to orthotopic liver transplant (OLT). Techniques that have been described to date, however, are unnecessarily complex and increase the likelihood of morbidity and adverse outcome. MATERIALS AND METHODS Male outbred weanling pigs underwent OLT according to our procedure, with a short anhepatic time (<20 min) and without veno-venous bypass or vasoactive substances during the anhepatic phase. Vascular anastomoses were performed identical to the clinical setting, and a simple stented choledochocholedochostomy was created. RESULTS The authors have performed this procedure 130 times using four transplant models: standard, whole-liver (n = 10), small-for-size (n = 48), donor after cardiac death (n = 44), and donor adenoviral gene transfection (n = 28). The average cold ischemic and anhepatic times were 302 ± 43 and 17 ± 3 min, respectively. Hypotension was successfully treated with intravenous fluids. In all cases, the recipient survived the operation and was extubated. Survival to the end follow-up varied according to the model and was 56% (73/130) for all cases. At autopsy or euthanasia, no vascular thrombosis or outflow obstruction was found. Survival was 100% for pigs transplanted with standard, whole-liver grafts (n = 10). In this group, AST and bilirubin rose during the first 24 h after graft reperfusion, while the Quick prothrombin time (QPT) fell. By the fifth postoperative day, these parameters had returned to baseline. CONCLUSIONS This model is straightforward and reproducible and offers surgeons and researchers the opportunity to perform OLT studies under clinically relevant conditions.
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Affiliation(s)
- Constantino Fondevila
- Liver Transplant Unit, Department of Surgery, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
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