Orthotopic liver retransplantation in rats

A surgical experience with a method of rat orthotopic liver retransplantation (OLRT), and a preliminary study of immunological responses after OLRT are reported. OLRT was performed on the same recipient after the first orthotopic liver transplantation (1st-OLT) according to our original (Kamada's) cuff method. Replacement of the portal vein (PV) and infra-hepatic vena cava (IHVC) cuffs was not technically difficult. However, there were no survivors from the first 6 retransplanted rats, mainly due to complications from defective supra-hepatic vena cava (SHVC) anastomoses. Unlike the human intra-abdominal SHVC, the posterior wall of the intraabdominal SHVC in rats is too short and fragile to perform an end-to-end anastomosis twice between donor and recipient SHVC. For a second group of seven retransplants, a modification of the SHVC anastomosis was made between donor and recipient SHVC in conjunction with the recipient's cuff diaphragm. This enabled reanastomosis to be secure, resulting in the improved 1-week survival after isogeneic OLRT (85.7%). This OLRT model has been applied to the fully allogeneic combination for several immunological studies and led to novel findings. Thus, an experimental model of a rat orthotopic liver retransplant model has the potential to allow more valuable insights into the immunological study of chronic rejection, sensitization and chimerism following liver retransplantation. © 1995 Wiley-Liss, Inc.     

单人操作建立小鼠原位肝移植模型

目的：探讨一种能稳定、高效地建立小鼠原位肝移植模型且能单人操作的手术改良方法。方法：参照“双袖套”法,肝上下腔静脉采用连续缝合,门静脉、肝下下腔静脉采用袖套法,胆管用支架法吻合,完成小鼠原位肝肝移植70例。术后观察24 h,1周和1个月受体存活率,肝功能及肝组织病理变化。并设立假手术组对照。结果：受体术后24 h,1周和1个月存活率分别为95.7%,90.9%和85.1%。术后1周ALT逐渐升高,1个月降至正常水平;术后ALP值逐渐增高;病理显示肝组织结构良好。结论：该方法成活率高,稳定性好,重复性强,是建立小鼠原位肝移植模型的理想方法。     

Novel technique for suprahepatic vena cava reconstruction in rat orthotopic liver transplantation

In previous studies, the suture technique and the cuff method were applied to anastomoses of the suprahepatic vena cava (SHVC) in rat orthotopic liver transplantation. However, the anastomosis of SHVC is difficult during transplantation because of the short length of the SHVC. Here, we developed a novel method for anastomoses of SHVC, using a veno-lined stent technique. The veno-lined stent for SHVC anastomosis was prepared after the donor operation. The special veno-lined stent was a 4.0-mm-long polythene tube in which a venous segment from the donor was lined. During the recipient operation, the donor SHVC was anastomosed end-to-end to the recipient SHVC, using the veno-lined stent. Anastomoses of the portal vein and infrahepatic vena cava were performed using a cuff technique. Continuity of the bile duct was established using a stent. The hepatic artery was ligated, and the graft was not arterialized. As controls, the unlined stent, the suture technique, and the cuff method were also used for SHVC anastomoses, respectively, as three control groups with the identical procedures above. In total, 30 orthotopic liver isografts were performed using the veno-lined stent technique. The survival rate was 90% (27/30) after 1 week and 70% (21/30) after 2 months, with normal hepatocellular function. The SHVC anastomosis using a veno-lined stent took 10 +/- 2 (mean +/- SD) min. The anhepatic phase, recipient operative time, and complete operation time were about 14 +/- 2 min, 40 +/- 5 min, and 120 +/- 10 min, respectively. However, in the nonlined stent control group, a total of 20 orthotopic liver isografts used the nonlined stent for SHVC anastomoses, and all failed because of venous thrombosis in SHVC; none survived over 1 week. In the suture technique control group, 40 orthotopic liver isografts were performed using a suture technique for SHVC anastomoses. The results showed no significant difference with those of the veno-lined stent method. But in the cuff method control group, of all 20 orthotopic liver isografts performed using the cuff method for SHVC anastomoses, 10 failed because of failed ligation on the anastomostic site. The survival rates at 1 week and 2 months postoperatively were significantly different from those of the veno-lined stent method. The veno-lined stent technique provides a novel, simple, and reliable method for SHVC anastomoses. It avoids bleeding during suture and the ligation difficulties found with the cuff method. The operation's success rate is satisfactory. This model is successful, and could be applied in various experimental studies.     

不同肝上下腔静脉重建方法对大鼠肝移植术后血流动力学的影响

目的 本研究旨在探讨肝上下腔静脉的不同重建方法对大鼠肝移植术后血流动力学的影响.方法 根据Kamada二袖套法、改良内覆静脉支架法和Harihara三袖套法3种不同的肝上下腔静脉重建方法将SD大鼠分为3组,每组先取12对记录手术成功情况、手术操作时间、术后1个月受体存活情况、肝脏弹性模量值、静脉血栓发生情况等.另以10只相近体质量大鼠作为对照组,测定其肝脏弹性模量值.利用激光散斑灌注成像（LS PI）监测3组移植组受体移植肝复流后和对照组肝脏的微循环.术后24,72 h和1个月,3组移植组各时间点再另取6只存活受体进行血流动力学参数检测.结果 二袖套组、支架组和三袖套组手术成功比例分别为12/12,11/12和11/12.术后1个月,二袖套组、支架组和三袖套组分别有11（11/12）,9（9/11）和9（9/11）只受体存活,分别有0,7,4例发生静脉血栓;二袖套组发生静脉血栓比例低于支架组和三袖套组（P=0.000和0.026）.二袖套组、支架组和三袖套组术后1个月和对照组肝弹性模量值分别为7.0±0.4,15.3 ±1.6,7.5 ±0.7和5.6 ±0.7,各移植组均高于对照组（F=209.70,P ＜0.05）.移植肝复流后LSPI流量值逐步增加,但复流3,10,20 min后,各移植组间LSPI流量值差异无统计意义（F=1.96,3.81和1.65,P均＞0.05）;复流20 min时,各移植组LSPI流量值仍低于对照组（F =237.65,154.02和50.95,P均＜0.05）.将对照组大鼠血流动力学结果作为正常参考值,各移植组术后肝下下腔静脉（IHVC）和门静脉（PV）血流量、压力均逐渐升高.术后24,72 h和1个月,3组移植组大鼠IHVC和PV血流量均低于对照组,支架组最低（F=71.4和54.3,79.8和54.3,84.5和29.6,P均＜0.05）;3组移植组大鼠IHVC压力均高于对照组,支架组最高（F=73.5、159.8和110.1,P＜0.05）.术后24,72 h,二袖套组和三袖套组PV压力均低于对照组,而支架组高于对照组（F =126.6和193.5,P均＜0.05）.术后1?     

Magnetic ring anastomosis of suprahepatic vena cava: novel technique for liver transplantation in rat

To improve the technique of suprahepatic vena cava (SHVC) reconstruction in rat OLT, novel magnetic rings were designed and manufactured to facilitate reconstruction of SHVC and shorten the anhepatic time. One‐hundred and twenty adult male Wistar rats were randomly divided into two groups: rings group (n = 30), using magnetic rings for SHVC reconstruction; suture group (n = 30), 7/0 prolene suture was used for SHVC running anastomosis as control. Cuff techniques were used for portal vein and infrahepatic vena cava reconstruction as Kamada and Calne described. The bile duct was reconnected with a stent. The hepatic re‐arterialization was omitted. In the rings group, the SHVC reconstruction took 0.91 ± 0.24 (mean ± SD) min; the anhepatic phase and the recipient operation time were 5.63 ± 0.65 min and 36.02 ± 8.02 min, respectively. In suture group, the anastomotic time of SHVC was 10.40 ± 2.11 min; the anhepatic phase and the recipient operation time were 17.76 ± 2.51 and 49.38 ± 12.06 min, respectively, and there was statistically significant difference between the two groups. The ALT levels reached peak at 24 h post‐OLT (186.2 ± 32.5 IU/l) and restored to normal level at 96 h gradually. In the rings group, 29 of 30 rats survived at day 7 and 28 of 30 rats survived at day 30. In contrast, only 25 of 30 recipients in suture group remained alive at day 7 and 22 of 30 remained alive at day 30 (P < 0.05). Better anastomotic healing was founded in rings group by pathology and scanning electron microscope. The magnetic rings technique provides a novel, simple method for SHVC reconstruction of OLT in rat. It significantly shortens anhepatic phase, while the success rate of the operation is satisfactory.     

Rat liver transplantation for total vascular reconstruction, using a suture method

We developed a novel protocol for rat orthotopic liver transplantation (OLT), using a suture method to establish hepatic artery flow. After determining that early inferior vena cava (IVC) unclamping maintained better circulation compared with the portal vein (PV) using porto-systemic shunted recipients, we developed a rat OLT model with total vascular reconstruction using a suture method. After connecting the suprahepatic IVC, the infrahepatic IVC was anastomosed, using a running suture method. IVC circulation was established immediately. The PV was anastomosed without intestinal congestion, using porto-systemic shunted recipients. The aortic conduit, including the donor celiac and hepatic artery, was anastomosed to the recipient abdominal aorta end-to-side. Eight of 11 OLT cases (72.7%) survived indefinitely. Biliary connection was achieved using a one-stent method. Three cases died 3-5 days postoperatively. Hepatic angiography showed good patency. The graft liver was histologically normal in long-surviving rats.     

Improved technique for infrahepatic vena cava reconstruction in guinea pig-to-rat liver transplantation

Guinea pig-to-rat orthotopic liver transplantation is associated with serious technical problems contributing to impaired graft perfusion and primary graft failure. In order to shorten the procurement procedure and thereby minimize liver damage before flushing, a simplified technique for infrahepatic caval reconstruction was developed. Dissection of the infrahepatic vena cava (IHVC) from adrenal glands and renal and lumbar veins represents the most difficult and time-consuming part of the donor operation, which is often not well tolerated by the animal; we avoided this step by using an isogeneic vena cava interposition graft (VCIG) following in situ perfusion. This graft is connected with the IHVC transsected just below the liver with a cuff technique. Donor operations lasted 15 to 20 minutes with the new technique (n = 7) compared to 52 to 76 minutes with conventional technique (n = 7). Reduced operating time was associated with markedly improved graft perfusion and significantly better graft survival. This modification of the donor procedure for the guinea pig-to-rat liver xenograft using a VCIG significantly reduces operating time and improves reperfusion and recipient survival.     

Emergency endovascular repair for traumatic injury of the inferior vena cava

Conventional open repair of the traumatic injuries of the inferior vena cava still represents a surgical challenge, since it carries high morbidity and mortality rates close to 100% in emergency setting. Surgical techniques required the total mobilization of the liver in the former case and the anatomic exposure of the aorto-iliac bifurcation in the latter. We report a case of uncontrolled hemorrhage from the inferior vena cava, managed by endovascular technique. A 65-year-old woman underwent endovascular stent-grafting for traumatic injury of the inferior vena cava. We performed the endovascular approach as we similarly did for aortic repair using a simple groin access through the common femoral vein; no additional dissection of the inferior vena cava or adjacent structures was needed using endovascular approach, thus avoiding additional operative trauma, and time with the stent-graft procedure was 9 min. Inferior vena cava stent-grafting without laparotomy and retroperitoneal dissection is feasible and could be a very attractive alternative to open surgery for rupture of the vena cava.     

Colon transplantation: A new microvascular technique

This paper describes a new transplantation technique, using the colon instead of the small bowel for intestinal transplantation. With microsurgical techniques, aljogeneic colon transplantation was carried out in rats in a hetero-topic fashion. The vascular pedicle containing the aortic cuff and the portal vein was anastomosed to the aorta and the inferior vena cava of the host, respectively. The technique has proven reliable and reproducible, and our preliminary results suggest that the colon produces a milder rejection response than transplantation of the small bowel. © 1993 Wiley-Liss Inc.     

原位肝移植术后静脉流出道梗阻的原因和处理

目的 探讨原位肝移植术后静脉流出道梗阻的原因和处理方法.方法 对2000年1月至2006年12月收治的776例同种原位肝移植患者的临床资料进行回顾性分析.总结原位肝移植术后静脉流出道梗阻的诊治经验.结果 776例肝移植患者中共发生术后静脉流出道梗阻10例,发生率为1.29%.其中肝上下腔静脉吻合口狭窄6例,肝后段下腔静脉狭窄2例,肝静脉流出道梗阻2例.10例均进行了下腔静脉造影而明确诊断,8例患者在下腔静脉造影的同时施行了气囊扩张或放置血管内支架术,2例介入治疗效果不佳而中转再次肝移植术;该组因术后静脉流出道梗阻而死亡3例,与静脉流出道梗阻相关的病死率为30%(3/10).结论 原位肝移植术后静脉流出道梗阻的发生与腔静脉的吻合技术,腔静脉吻合方式以及供肝体积与受者肝床不匹配有关;术后尽早发现流出道梗阻的存在,并及时做出正确的治疗选择如介入治疗或再次肝移植等是改善该并发症预后的关键.     

Technique for retransplanting heterotopic heart grafts in mice

Removal of a transplanted organ from its original recipient and retransplanting it into a new host is an important method to study the role of the graft in the rejection process. Here we describe a novel technique of heart retransplantation in the mouse. In this technique, a primarily vascularized heart graft is anastomosed to the abdominal aorta and inferior vena cava of a syngeneic or immunodeficient allogeneic mouse, using standard techniques. Either 10 or 70 days later, the same graft is retransplanted into the abdomen of a second mouse by end-to-side anastomosis of the donor (first recipient) aortic and inferior vena cava's cuffs to the second recipient's abdominal aorta and inferior vena cava, respectively. A greater than 90% success rate was achieved by using this microsurgical technique. This method should be useful for studying intragraft factors, such as ischemia-reperfusion injury and donor antigen-presenting cells, on the outcomes of transplantations.     

Leiomyosarcoma of the retrohepatic vena cava treated by excision and reconstruction with an aortic homograft: a case report and review of literature

Leiomyosarcoma of the retrohepatic inferior vena cava is a rare entity and presents a number of diagnostic and therapeutic challenges. Here such a case is presented in which the retrohepatic inferior vena cava was excised after full mobilization of the liver under venovenous bypass. The continuity of the vena cava was restored with cryopreserved aortic homograft. The technical details with regard to total vena caval clamping, venovenous bypass, hepatic inflow occlusion, techniques of reconstruction, including the use of cryopreserved aortic homograft, and a brief review of the literature on the surgical management of retrohepatic inferior vena caval tumors are discussed.     

Review of various techniques of pancreas transplantation in rat model

Pancreas transplantation (PTx) is being applied with increasing frequency in the treatment of diabetes mellitus Type 1 and selected cases of Type 2. It is known that PTx can consistently establish normoglycemic insulin-independent state. Due to the increased use of different PTx models in rats for studying the metabolic function of the transplanted pancreas, reviewing the various techniques in PTx seemed to be necessary. A review of the literature of PTx in rat models showed that different techniques or modifications have been described. Each modification is the result of a change or simplification of three main points: the arterial inflow, the venous outflow, and the management of the exocrine secretory part of the gland. The techniques of PTx vascularization in rats are based on two cardinal models, which include the microsuture and non-suture cuff techniques. In arterial inflow reconstruction, an aortic segment is used. Venous drainage is accomplished by systemic or portal drainage (porto-caval or porto-portal anastomosis). Management of the exocrine part has the most variations. Enteric and urinary diversion, as well as duct ligation or obstruction, are the most important techniques for the management of exocrine part. Regarding vascular anastomosis, the microsuture technique is more popular than the cuff technique. However the cuff technique seems to be simpler. Grafts with portal venous drainage show a lesser probability of hyperinsulinemia and a high level of lipoproteins. In the management of the exocrine part, enteric exocrine drainage is more similar to the physiological setting and is associated with a significant reduction in the incidence of acidosis and dehydration. However, enteric diversion is more prone to intestinal bleeding and ileus as well as to bacterial contamination. The technique for PTx in rat varies according to surgeons' experiences and preferences as well as their research objectives.     

Use of vena cava to obtain additional length for the right renal vein during transplantation of cadaveric kidneys

During cadaveric organ harvesting removal of the right renal vein and a segment of the vena cava may facilitate venous anastomosis of the right kidney. The technique to obtain adequate length of the right renal vein using the vena cava is simple, physiological and effective. A segment of the inferior vena cava should be harvested with the right but not necessarily with the left kidney. The use of a long segment of vena cava makes the renal transplantation much easier and does not interfere with multiorgan procurement. The method is most useful when the right renal vein is extremely short or when the recipient has a large abdomen and a deep pelvis.     

Retrohepatic cavoatrial bypass for coarctation of inferior vena cava with a polytetrafluoroethylene graft

Eight patients with chronic Budd-Chiari syndrome resulting from coarctation of the inferior vena cava underwent operation. Transatrial dilatation was of no avail in the first case. The obstructed segment was directly visualized in the subsequent seven cases by a transthoracic, transdiaphragmatic, retroperitoneal approach. In these latter seven cases, severe hourglass constriction of the inferior vena cava was observed just above the right hepatic vein. There was no evidence of inflammation, extrinsic compression, or thrombosis. Retrohepatic cavoatrial bypass with an antibiotic-sterilized aortic homograft was unsuccessful in three patients. Five patients including one with homograft failure underwent successful retrohepatic cavoatrial bypass with a polytetrafluoroethylene graft (20 mm plain in four cases and 16 mm ringed graft in one case). These patients have been followed up for 21 months to 6 years with no recurrence of symptoms. The term coarctation of the inferior vena cava appears more appropriate than membranous obstruction of the inferior vena cava because of the operative findings in the present series.     

Aortic and inferior vena cava resection for renal cell carcinoma invading an aberrant renal vein

Renal cell carcinoma which invades the renal veins is a frequent complicating factor in radical nephrectomy. In a 53-year-old patient with a left renal cell carcinoma, tumor thrombus was present in an aberrant, retroaortic left renal vein, and "en bloc" resection of the overlying aneurysmal aorta with a cuff of inferior vena cava was required. The aorta was reconstructed with a dacron bifurcation graft to the iliac arteries, and the vena cava closed primarily. The patient made an uneventful postoperative recovery. The requirement for extensive aortic and vena cava resection need not compromise attempts to cure locally advanced renal cell carcinoma.     

Leiomyosarcoma of the inferior vena cava: analysis and search of world literature on 141 patients and report of three new cases

Leiomyosarcoma of the inferior vena cava is a rare and potentially curable tumor. Uncertainty about the results of treatment derives from lack of a large series in the same center and of a long-term follow-up of the published cases. A review of the world literature from 1871 to 1989 allowed us to collect information on 141 patients with inferior vena cava leiomyosarcoma to which our three cases have to be added. The tumor arose from the lower segment of the inferior vena cava (infrarenal portion) in 49 patients, from the middle segment (from the renal veins to the hepatic veins) in 59, and from the upper segment (from the hepatic veins to the right atrium) in 34 patients. Complete clinical, pathologic, and therapeutic data and up-to-date follow-up have been obtained through personal correspondence with several authors. All data have been examined with both univariate and multivariate analyses as predictive factors for outcome. Variables, associated with an increased risk of death from disease, included the involvement of inferior vena cava upper segment and a high-grade tumor. Patients who underwent a radical resection of the tumor (82 patients, 56.9%) had a significantly better survival (27.9% and 14.2%, 5- and 10-year survival rates, respectively). Of these patients, those with tumor of the inferior vena cava middle segment fared better than those with lower segment tumor (5- and 10-year survival rates were 48.3% and 34.4%, respectively, for middle segment tumor and 9.3% and 0.0% for lower segment tumor). Variables associated with a good outcome and longer survival were the presence of abdominal pain and the absence of a palpable abdominal mass. Despite the high rate of recurrence (52.4% of patients undergoing radical operation; median time, 25 months), radical resection of inferior vena cava leiomyosarcoma is the only chance for a long-term cure. An earlier and more accurate preoperative diagnosis, by means of modern diagnostic techniques (echography, CT scanning, magnetic resonance imaging) will allow a higher rate of radical resection to be performed with an increase in patient survival.     

改进的门静脉套管置人技术在大鼠肝移植中的应用

目的 探讨改进的门静脉套管置入技术“门脉分支悬吊法”在大鼠肝移植门静脉重建中的应用效果.方法 “双袖套法”建立大鼠肝移植模型,分别应用改进的“门脉分支悬吊法”和传统方法行受体门静脉重建,比较门静脉重建所需时间和成功率、无肝期时间以及移植手术成功率.结果 应用改进的“门脉分支悬吊法”行大鼠肝移植(n=35),受体门静脉重建成功率94.3％,门静脉吻合所需时间仅为(1.9±0.7)min,无肝期为(21.8±2.2)min,移植手术成功率为80％,优于传统方法(P＜0.05).术后l周存活率为85.8％,与传统方法比较无统计学差异(P＞0.05).结论 改进的“门脉分支悬吊法”缩短了受体门静脉吻合时间和无肝期,提高了门静脉重建成功率和移植手术成功率,可以快速、安全地实现大鼠肝移植受体手术中的门脉套管置入和门静脉重建.     

一种新型大鼠门腔静脉转位模型的建立

目的探讨一种新型大鼠门腔静脉转位模型建立的可行性。方法大鼠40只,采用袖套法建立同种异体血管门腔静脉转位模型。于左肾静脉末端安装一袖套,将左肾静脉与门静脉残端借袖套连接,贴近左肾静脉上方结扎并剪断下腔静脉,将下腔静脉借同种异体血管及袖套与肠系膜上静脉连接。另取10只大鼠切除左肾后作为对照组。观察术后大鼠的体重、生化指标、核磁共振及其肝脏病理学变化。结果40只大鼠门腔静脉转位后近、远期存活良好,术后24h至2月存活率均为97．50％（39／40）。术后2周核磁共振检查显示血流通畅。与对照组比较,实验组大鼠术后2月白蛋白、谷丙转氨酶、碱性磷酸酶和总胆红素、体重等指标差异均无统计学意义。术后2月肝组织病理检查结果正常。结论采用同种异体血管借助袖套方法建立大鼠门腔静脉转位模型是可行的。