| Autor: |
Beetz O; Department of General, Visceral and Transplant Surgery, Hannover Medical School; Beetz.Oliver@mh-hannover.de., Oldhafer F; Department of General, Visceral and Transplant Surgery, Hannover Medical School., Weigle CA; Department of General, Visceral and Transplant Surgery, Hannover Medical School., Cammann S; Department of General, Visceral and Transplant Surgery, Hannover Medical School., DeTemple D; Department of General, Visceral and Transplant Surgery, Hannover Medical School., Sieg L; Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School., Eismann H; Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School., Palmaers T; Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School., Vondran FWR; Department of General, Visceral and Transplant Surgery, Hannover Medical School. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of visualized experiments : JoVE [J Vis Exp] 2022 Aug 17 (186). Date of Electronic Publication: 2022 Aug 17. |
| DOI: |
10.3791/64152 |
| Abstrakt: |
Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft failure, ongoing organ donor shortages, and the increased use of marginal grafts call for the improvement of current concepts, such as the implementation of organ machine perfusion. In order to evaluate new methods of graft reconditioning and modulation, translational models are required. With respect to anatomical and physiological similarities to humans and recent progress in the field of xenotransplantation, pigs have become the main large animal species used in transplantation models. After the initial introduction of a porcine orthotopic liver transplant model by Garnier et al. in 1965, several modifications have been published over the past 60 years. Due to specifies-specific anatomical traits, a veno-venous bypass during the anhepatic phase is regarded as a necessity to reduce intestinal congestion and ischemia resulting in hemodynamic instability and perioperative mortality. However, the implementation of a bypass increases the technical and logistical complexity of the procedure. Furthermore, associated complications such as air embolism, hemorrhage, and the need for a simultaneous splenectomy have been reported previously. In this protocol, we describe a model of porcine orthotopic liver transplantation without the use of a veno-venous bypass. The engraftment of donor livers after static cold storage of 20 h - simulating extended criteria donor conditions - demonstrates that this simplified approach can be performed without significant hemodynamic alterations or intraoperative mortality and with regular uptake of liver function (as defined by bile production and liver-specific CYP1A2 metabolism). The success of this approach is ensured by an optimized surgical technique and a sophisticated anesthesiologic volume and vasopressor management. This model should be of special interest for workgroups focusing on the immediate postoperative course, ischemia-reperfusion injury, associated immunological mechanisms, and the reconditioning of extended criteria donor organs. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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