Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation in pigs

Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation

PURPOSE: Multivisceral transplantation (MVTx) has been accepted as standard therapeutic modality for patients with short-bowel syndrome associated with irreversible liver failure. Even nowadays, experimental models of MVTx grounds high incidence of intraoperative or early recipient mortality. Despite the known deleterious effects of hepatosplanchnic exenteration the impact of this procedure on systemic hemodynamics and metabolism remains to be determined. METHODS: Nine dogs (20.1±0.5 kg) were subjected to an en bloc resection of all abdominal organs including, stomach, duodenum, pancreas, liver, spleen, small bowel, and colon. A woven double velour vascular graft was interposed between the suprahepatic and infrahepatic vena cava. Systemic hemodynamic were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes, and arterial lines. Systemic O2-derived variables, glucose, and lactate metabolism were analyzed throughout the experiment. RESULTS: Complete abdominal exenteration was associated with significant reduction in cardiac output, and mean arterial pressure (57% and 14%, respectively). Two hours after reperfusion a significant reduction in arterial pH and glucose were also observed. Oxygen consumption remained unaltered during the first two hours of the experiment, with a significant increase of lactate levels (1.4±0.3 vs. 7.6±0.4, p<0.05). Three animals died before the 3 hours of reperfusion were completed. Total abdominal exenteration for MVTx in dogs is associated with early major hemodynamics, and metabolic changes. CONCLUSION: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure.

Immunological Advantage on Small Bowel Graft Induced by Simultaneously Transplanted Liver in Porcine Auxiliary Liver/Small Bowel Transplantation

BACKGROUND

We developed a new porcine model for auxiliary liver/small bowel transplantation (LSBT). The possible immunological advantage on small bowel graft induced by simultaneously transplanted liver in the large animal was assessed.

METHODS

Thirty outbreed long-white pigs were randomized into two groups. Group A animals received LSBT without immunosuppressive treatment (n = 10). Group B animals had segmental small bowel allotransplantation without immunosuppressive treatment (n = 10). The postoperative survival time, initial acute rejection time, and pathological rejection scores were analyzed.

RESULTS

There was no remarkable difference in survival time between groups A and B (10.33 days vs 12.89 days, P > .05), but the initial time of acute rejection in intestinal grafts in group A was obviously delayed when compared to group B (8.22 days vs 4.33 days, P < .05), and the rejection scores in group A were remarkably lower than those of group B (0 vs 0.44 on postoperative day (POD) 3, P < .05; 0.22 vs 1.78 on POD 5, P < .05; 1.11 vs 2.56 on POD 7, P < .05).

CONCLUSIONS

An immunological advantage on intestinal graft can be induced by simultaneously transplanted liver in auxiliary LSBT. Compared to isolated segmental small bowel allotransplantation, the intestinal graft in LSBT has a delayed initial time of acute rejection and lower acute rejection scores. The liver graft may reduce the risk of intestinal rejection and thus protect the bowel graft.

Education and research using experimental pigs in a medical school

Medium-sized animals such as miniature pigs are considered to be important for education and training in medical schools to master the skills required in surgical treatment. Much still remains to be done to establish total management for animal experiments using pigs. Improvement of the effective utilization of pigs is also required from the economical and ethical points of view. We have been providing a support system at a facility for experimental animals in a medical school for 3 years, and herein we introduce our personal experiments as an instructional lecture. Before starting surgical training using live pigs, sufficient education concerning animal ethics and dry laboratory training was completed. Four kinds of miniature pigs have been used as experimental animals; porcine rearing pens have been improved and a postoperative care system has been implemented. Moreover, staff at the center offer a preoperative service of anesthesia for surgical education, training, and research. Chronic experiments have increased to represent 35% and 48% of experiments using pigs in 2003 and 2004, respectively. Experimental pigs have undergone secondary use after being killed to reduce the number of animals used in experiments. Sharing and reuse have allowed effective use of miniature pig tissues and cells for research, and have reduced the number of animals used. We recommend that researchers consider use of our total systems because they can improve the quality of medical education and research and facilitate effective use of tissues and cells by sharing and reuse among different departments.

Immuno-protective effect of liver on small bowel in combined transplantation of liver and small bowel

AIM: To develop a new combined transplan-tation model of liver and small bowel in rats, and to investigate the protective effect of trans-planted liver on transplanted small bowel.

METHODS: Closed colony Sprague Dawley rats and inbred Wistar rats were included in this study. Five groups were designed: isogene small bowel transplant group (A), isogene liver transplant group (B), xenogene small bowel transplant group (C), xenogene liver transplant group (D), combined transplant of liver and small bowel group (E). Only Wistar rats were used in group A and B, while SD and Wistar rats were used as donors and recipients respectively in group C, D and E. During the combined transplantation of liver and small bowel (CTLS) for the donors, inferior vena cava in chest was cut to construct a muff in the lateral wall of portal vein and cuff was placed. During the operation for the recipients, portal veins of the donors and recipients were connected using cuff technique, and re-arterialization was completed by anastomosing the superior mesenteric artery of graft with the right kidney artery of the recipients. Randomly selected 4 rats from each group were sacrificed on postoperative days (POD) 5, 7 and 14, and grafts were sampled. The rejection of graft was investigated through histopathological analysis, and the apoptosis of the cells of graft were evaluated by TUNEL.

RESULTS: The survival rate of CTLS was 73.3% (22/30). The pathological changes of ischemia and reperfusion injury were observed in group A and B, and the numbers of apoptotic cells in the grafts were decreased with the prolonging of time. However, acute rejection after transplantation appeared in group C and D, and there were more apoptotic cells in the grafts. Mild, moderate and severe acute rejection occurred on POD 5, 7 and 14, respectively in group C, while only mild or severe acute rejection appeared in group E. Furthermore, the number of apoptotic cells in the grafts of group E was markedly decreased on POD 14 in comparison with that of group C (16.9 ± 4.3 vs 20.5 ± 6.3, P < 0.05). The degrees of acute rejection after transplantation and cell apoptosis of the grafts were not significantly different between group D and E.

CONCLUSION: The technique used in this study is feasible for establishment of CTLS model, and the transplanted liver can protect the transplanted intestinal graft from rejection in CTLS.

Effects of extrogenous aFGF on bax and bcl-2 expression in intestinal cells after ischemia/reperfusion

AIM: To detect the effects of acid fibroblast growth factor (aFGF) on apoptosis and Bax and bcl-2 expression in rat intestine after I/R injury, and to explore the protective mechanisms of aFGF on intestinal villus.

METHODS: One hundred and eight Wistar rats were randomly divided into 4 groups, namely intestinal ischemia/reperfusion group (R, n = 48), intestinal ischemia group (I, n = 6), aFGF treatment group (A, n = 48) and sham-operated group (C, n = 6). The rats sustained 45 min of arteria mesenterica (SMA) occlusion to establish the ischemia model. At the beginning of reperfusion, rats in group R and A were treated with normal saline (0.15 mL) and aFGF (20 μg/kg, 0.15 mL) respectively. Then each six rats as a sub-group were reperfused for a duration of 0.25, 0.5, 1, 2, 6, 12, 24, 48 h respectively. Cell apoptotic rates in intestinal villus were determined with terminal deoxynucl-eotidy transferase mediated dUTP-biotin nick-end-labeling technique (TUNEL). RT-PCR was used to detect the expressions of bax and bcl-2 gene in intestinal villus. Immunohistochemical methods were adopted to detect bax and bcl-2 protein expressions and distributions.

RESULTS: The improvement of intestinal histological structures was observed at 2 h, 6 h and 12 h after the reperfusion in group A, compared with group R. The apoptotic rates were (41.17±3.49 %), (42.83±5.23 %) and (53.33±6.92 %) at 2, 6, 12 h after reperfusion respectively in group A, and these rates were significantly lower than those in group R (P < 0.05). The expressions of bax gene and bax protein in intestinal villus were gradually increased after ischemia/reperfusion, while the transcription of bcl-2 gene and expression of bcl-2 protein were decreased. During the 2-12 h of reperfusion, the transcription of bcl-2 gene and expression of bcl-2 protein were significantly increased in group A compared with those in group R (P < 0.05). However, the expressions of bax gene and bax protein were significantly higher than those in group R (P < 0.05).

CONCLUSION: Intravenous aFGF could alleviate I/R-induced injury, in which its effects on the facilitation of bcl-2 transcription and inhibition of bax expression may play an important role.