Step-by-Step Guide for a Simplified Model of Porcine Orthotopic Liver Transplant
Step-by-Step Guide for a Simplified Model of Porcine Orthotopic Liver Transplant
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DOI：
10.1016/j.jss.2011.01.012
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发表时间：
2011-05-01
影响因子：
2.2
通讯作者：
Garcia-Valdecasas, Juan C.
中科院分区：
文献类型：
--
作者：
Fondevila, Constantino;Hessheimer, Amelia J.;Garcia-Valdecasas, Juan C.
背景基于与人类相似的解剖学、生理学和大小，猪为研究与原位肝移植（奥尔特）相关的新疗法提供了极好的手段。然而，迄今为止已经描述的技术是不必要的复杂，并且增加了发病率和不良结果的可能性。根据我们的方法对雄性远系断奶仔猪进行原位肝奥尔特，无肝时间短（< 20 min），无肝期无需静脉-静脉转流或血管活性物质。血管吻合术与临床相同，并建立了简单的支架胆总管吻合术。作者使用四种移植模型进行了130次该手术：标准，全肝（n =10），小尺寸（n = 48），心脏死亡后供体（n = 44）和供体腺病毒基因转染（n = 28）。平均冷缺血和无肝时间分别为302 +/- 43和17 +/- 3分钟。通过静脉输液成功治疗了低血压。在所有情况下，受体在手术中存活并拔管。随访结束时的生存率因模型而异，所有病例均为56%（73/130）。在尸体解剖或安乐死时，没有发现血管血栓形成或流出道阻塞。移植标准全肝移植物的猪存活率为100%（n = 10）。在该组中，AST和胆红素在移植物再灌注后的第一个24小时内上升，而快速凝血酶原时间（QPT）下降。到术后第5天，这些参数已恢复到基线水平。该模型简单且可重复，为外科医生和研究人员提供了在临床相关条件下进行奥尔特研究的机会。(C)2011 Elsevier Inc. All rights reserved.
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. (C) 2011 Elsevier Inc. All rights reserved.