Limits...
Development of a New Technique for Reconstruction of Hepatic Artery during Liver Transplantation in Sprague-Dawley Rat.

Liu X, He C, Huang T, Gu J - PLoS ONE (2015)

Bottom Line: During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes.The patency rate was 94.44% and the 4-week survival rate was 90%.Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.

View Article: PubMed Central - PubMed

Affiliation: Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of pathology; Collaborative and Creative Center, and Center of Translation Medicine, Shantou University Medical College, Shantou, Guangdong, China.

ABSTRACT

Background: Sleeve anastomosis is the most common technique used to rearterialize orthotopic liver transplants (OLT). However, this technique has a number of disadvantages, including difficulty of performance of the technique visually unaided. We herein describe a novel rearterialized OLT model in the rat.

Materials and methods: Forty-six male Sprague Dawley rats (300-400 g) were used as donors and recipients. Based on Kamada's cuff technique, the new model involved performing a modified "sleeve" anastomosis between the celiac trunk of the donor and common hepatic artery of the recipient to reconstruct blood flow to the hepatic artery. An additional ten male Sprague Dawley rats underwent liver transplantation without artery reconstruction. Liver grafts were retrieved from the two groups and histological examination was performed following surgery.

Results: Total mean operating times were ~42 minutes for the donor liver extraction and 57 minutes for the recipient transplantation. Graft preparation took an additional 15 minutes and the time to fix the arterial bracket was ~3 minutes. During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes. The patency rate was 94.44% and the 4-week survival rate was 90%. Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.

Conclusions: This new method allows for the surgical procedure to be performed visually unaided with good survival and patency rates and represents an alternative model investigating OLT in rats.

Show MeSH

Related in: MedlinePlus

Depiction of the procedure of vessel anastomosis between donor celiac axis and recipient common hepatic(CHA).The vessel end of the recipient CHA and the donor celiac axis were placed closely to facilitate the anastomosis. (A): The first suture was performed with a length of 10–0 silk from outside to inside of the donor celiac axis and the suture was placed approximately 1 mm beyond the bracket. (B): The suture went transmurally through the anterior edge of the recipient CHA. (C): The donor celiac axis was repierced from inside to outside near the first suture point by the same thread. (D): Finally, the thread was pulled gently to guide the recipient CHA onto the donor celiac axis, and the suture was tied. Fig 3-(1) is diagram illustration showing the 4 steps of anastomosis. Fig 3-(2) shows the 4 steps with real photos of surgical procedure.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4696743&req=5

pone.0145662.g003: Depiction of the procedure of vessel anastomosis between donor celiac axis and recipient common hepatic(CHA).The vessel end of the recipient CHA and the donor celiac axis were placed closely to facilitate the anastomosis. (A): The first suture was performed with a length of 10–0 silk from outside to inside of the donor celiac axis and the suture was placed approximately 1 mm beyond the bracket. (B): The suture went transmurally through the anterior edge of the recipient CHA. (C): The donor celiac axis was repierced from inside to outside near the first suture point by the same thread. (D): Finally, the thread was pulled gently to guide the recipient CHA onto the donor celiac axis, and the suture was tied. Fig 3-(1) is diagram illustration showing the 4 steps of anastomosis. Fig 3-(2) shows the 4 steps with real photos of surgical procedure.

Mentions: Reconstruction of the recipient hepatic artery was performed without the aid of an operating microscope. The recipient CHA was clamped at the beginning and transected at the end. The lumen of the vascular stump of both the donor and recipient were irrigated with saline solution. Loose adventitia of the recipient CHA was carefully removed up to the bifurcation of the celiac axis, while the adventitia of the donor celiac axis was gently removed from the first 2 mm of the stump. The vessel ends of both the donor and recipient were placed within a few millimeters. The guide suture pierced the vessel with 10–0 silk from outside to inside about 4 mm beyond the stump and about 1 mm beyond the bracket (Fig 3). The suture entered the lumen of the vessel, went through the bracket and out of the stump, and then the stitch went transmurally through the anterior edge of the recipient CHA. The stitch carefully went back into the lumen of the celiac axis and then pierced the vessel wall from inside to outside near the first suture point. Since the small bracket was inserted into the celiac axis to ensure that the vessel wall of the stump would not cave in, the operator could perform the guide suture placement easily and accurately. After the guide suture was in place, the thread of the suture was carefully pulled to guide the stump of the CHA into the lumen of the donor celiac axis, and slip through the bracket. The suture was then gently tied. When the vascular clamp was removed from the recipient CHA, the vessel began filling and no bleeding was found at the site of anastomosis (Fig 4). Vessels were inspected for patency by the presence of arterial engorgement and a positive filling test 5 minutes after completion of the anastomosis. After the HA reconstruction was completed, the recipient bile duct was incised on the anterior wall and the tube, which attached the donor bile duct, was tucked into the lumen of the recipient bile duct. The abdomen was closed using a running suture after the abdominal cavity was checked for hemostasis. After transplantation, the rats were allowed to recover from anesthesia in separate cages under an infrared lamp for half an hour, and subsequently returned to regular housing. Signs of distress and survival were monitored, during the first 12 hours post-transplantation rats were checked every 4 hours and subsequently every 8 hours for one week, and daily afterwards.


Development of a New Technique for Reconstruction of Hepatic Artery during Liver Transplantation in Sprague-Dawley Rat.

Liu X, He C, Huang T, Gu J - PLoS ONE (2015)

Depiction of the procedure of vessel anastomosis between donor celiac axis and recipient common hepatic(CHA).The vessel end of the recipient CHA and the donor celiac axis were placed closely to facilitate the anastomosis. (A): The first suture was performed with a length of 10–0 silk from outside to inside of the donor celiac axis and the suture was placed approximately 1 mm beyond the bracket. (B): The suture went transmurally through the anterior edge of the recipient CHA. (C): The donor celiac axis was repierced from inside to outside near the first suture point by the same thread. (D): Finally, the thread was pulled gently to guide the recipient CHA onto the donor celiac axis, and the suture was tied. Fig 3-(1) is diagram illustration showing the 4 steps of anastomosis. Fig 3-(2) shows the 4 steps with real photos of surgical procedure.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696743&req=5

pone.0145662.g003: Depiction of the procedure of vessel anastomosis between donor celiac axis and recipient common hepatic(CHA).The vessel end of the recipient CHA and the donor celiac axis were placed closely to facilitate the anastomosis. (A): The first suture was performed with a length of 10–0 silk from outside to inside of the donor celiac axis and the suture was placed approximately 1 mm beyond the bracket. (B): The suture went transmurally through the anterior edge of the recipient CHA. (C): The donor celiac axis was repierced from inside to outside near the first suture point by the same thread. (D): Finally, the thread was pulled gently to guide the recipient CHA onto the donor celiac axis, and the suture was tied. Fig 3-(1) is diagram illustration showing the 4 steps of anastomosis. Fig 3-(2) shows the 4 steps with real photos of surgical procedure.
Mentions: Reconstruction of the recipient hepatic artery was performed without the aid of an operating microscope. The recipient CHA was clamped at the beginning and transected at the end. The lumen of the vascular stump of both the donor and recipient were irrigated with saline solution. Loose adventitia of the recipient CHA was carefully removed up to the bifurcation of the celiac axis, while the adventitia of the donor celiac axis was gently removed from the first 2 mm of the stump. The vessel ends of both the donor and recipient were placed within a few millimeters. The guide suture pierced the vessel with 10–0 silk from outside to inside about 4 mm beyond the stump and about 1 mm beyond the bracket (Fig 3). The suture entered the lumen of the vessel, went through the bracket and out of the stump, and then the stitch went transmurally through the anterior edge of the recipient CHA. The stitch carefully went back into the lumen of the celiac axis and then pierced the vessel wall from inside to outside near the first suture point. Since the small bracket was inserted into the celiac axis to ensure that the vessel wall of the stump would not cave in, the operator could perform the guide suture placement easily and accurately. After the guide suture was in place, the thread of the suture was carefully pulled to guide the stump of the CHA into the lumen of the donor celiac axis, and slip through the bracket. The suture was then gently tied. When the vascular clamp was removed from the recipient CHA, the vessel began filling and no bleeding was found at the site of anastomosis (Fig 4). Vessels were inspected for patency by the presence of arterial engorgement and a positive filling test 5 minutes after completion of the anastomosis. After the HA reconstruction was completed, the recipient bile duct was incised on the anterior wall and the tube, which attached the donor bile duct, was tucked into the lumen of the recipient bile duct. The abdomen was closed using a running suture after the abdominal cavity was checked for hemostasis. After transplantation, the rats were allowed to recover from anesthesia in separate cages under an infrared lamp for half an hour, and subsequently returned to regular housing. Signs of distress and survival were monitored, during the first 12 hours post-transplantation rats were checked every 4 hours and subsequently every 8 hours for one week, and daily afterwards.

Bottom Line: During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes.The patency rate was 94.44% and the 4-week survival rate was 90%.Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.

View Article: PubMed Central - PubMed

Affiliation: Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of pathology; Collaborative and Creative Center, and Center of Translation Medicine, Shantou University Medical College, Shantou, Guangdong, China.

ABSTRACT

Background: Sleeve anastomosis is the most common technique used to rearterialize orthotopic liver transplants (OLT). However, this technique has a number of disadvantages, including difficulty of performance of the technique visually unaided. We herein describe a novel rearterialized OLT model in the rat.

Materials and methods: Forty-six male Sprague Dawley rats (300-400 g) were used as donors and recipients. Based on Kamada's cuff technique, the new model involved performing a modified "sleeve" anastomosis between the celiac trunk of the donor and common hepatic artery of the recipient to reconstruct blood flow to the hepatic artery. An additional ten male Sprague Dawley rats underwent liver transplantation without artery reconstruction. Liver grafts were retrieved from the two groups and histological examination was performed following surgery.

Results: Total mean operating times were ~42 minutes for the donor liver extraction and 57 minutes for the recipient transplantation. Graft preparation took an additional 15 minutes and the time to fix the arterial bracket was ~3 minutes. During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes. The patency rate was 94.44% and the 4-week survival rate was 90%. Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.

Conclusions: This new method allows for the surgical procedure to be performed visually unaided with good survival and patency rates and represents an alternative model investigating OLT in rats.

Show MeSH
Related in: MedlinePlus