2016, (2): 70-74.
Objective To summarize the experience of split-orthotopic liver transplantation model in swineswithout veno-venous bypass. Methods A total number of 40 Bama mini-swines were used in this study, whichwere randomly divided into donor group and recipient group, with 20 swines in each group. 20 cases of split-orthotopicliver transplantation without veno-venous bypass were performed under general anesthesia. Arterial blood gas analysis and hemodynamic parameters were measured. The influence of the management during operations was also discussed. Results Eighteen of the recipients were successfully extubated and awake 1-2 hours postoperations. Allswines can eat and drink normally on the second post-operative day. Three of them died on the third post-operative day because of abdominal infection. The survival rate of 5 days past operation was 65%. Compared with pre-anhepaticphase,the mean arterial pressure and central venous pressure were significantly decreased and the heart rate wassignificantly increase in anhepatic phase〔mean arterial pressure(mmHg):58.5±8.2 vs. 105.3±10.0,central venous pressure(cmH2O):2.17±2.11 vs. 5.51±4.06,heart rate(times/min):151.3±16.0 vs. 121.9±8.8,allP < 0.05〕. Compared with anhepatic phase,pH value was significantly decreased,K+ and the concentration of lacticacid were significantly increased in hepato-repepusion〔pH :7.307±0.083 vs. 7.514±0.071,K+ concentration (mmol/L):5.86±0.71 vs. 3.36±0.28,lactic acid(mmol/L):6.53±1.54 vs. 3.39±1.03,all P < 0.05〕. Conclusion Hemodynamic and arterial blood gas analysis changes significantly during split-orthotopic livertransplantation in swines. By using moderate vasoactive substances, to maintain the hemodynamic parameters stability in the anhepatic phase and the short anhepatic phase are important to perform successful split-orthotopic livertransplantation.
2016, (2): 75-78.
Objective To summarize the technical difficulties and experience in the orthotopic liver transplant swine model without veno-venous bypass, to establish the highly reproducible and stabile swine model for liver transplant research. Methods Liver transplant swine model without veno-venous bypass were established bythe using of BAMA miniature pigs from Feb 2015 to Jun 2015. Hemodynamics,arterial blood gas analysis and changes in biochemical indicators were monitored during the operation. The time of anhepatic phase,operation time,the amount of blood loss,the amount of blood transfusion and postoperative survival rate were monitored. Results A totalnumber of 27 liver transplantation models were established in swines without veno-venous bypass. Mean cold ischemic time of the donor liver was(125.3±20.4)mins,the mean time of anhepatic phase and operation were(20.6±2.3)mins and(178.7±26.3)mins,respectively. Compared with pre-anhepatic phase,hemodynamics and metabolism changedrapidly during anhepatic phase,central venous pressure(CVP),mean arterial pressure(MAP),pH value and base excess decreased significantly〔CVP(cmH2O):1.52±0.33 vs. 5.83±0.58,MAP(mmHg):52.34±5.73 vs. 94.53±7.87,pH :7.31±0.03 vs. 7.40±0.02,base excess(mmol/L):-8.34±3.70 vs. 0.64±2.02,all P < 0.05〕. Heart rate and serum potassium increased markedly.〔heart rate(times/min):148.00±7.74 vs. 92.00±9.64,serum potassium(mmol/L):4.82±0.52 vs. 4.13±0.37,all P < 0.05〕. Hemodynamics and metabolism graduallyreturn to normal after portal vein and inferior vena cava were opened and blood flow restored. The 3-days and 7-days post-operation survival rates were 96.3% and 88.9% respectively. Conclusion Maintaining hemodynamics stable, decreasing the time of anhepatic phase and reducing the operative complication were the key points of establishing liver transplantation swine model without veno-venous bypass.
2016, (2): 79-82.
Objective To improve the technique of suprahepatic vena cava(SHVC)reconstruction in rat orthotopic liver transplantation,novel magnetic rings were designed and manufactured to facilitatereconstruction of SHVC and shorten the anhepatic time. Methods 120 adult male Wistar rats were randomlydivided into two groups :rings group(n = 30),using magnetic rings for SHVC reconstruction ;suture group (n = 30),7-0 prolene sutures were used for SHVC running anastomosis as control. Cuff techniques were used forportal vein and infrahepatic vena cava reconstruction as Kamada and Calne described. Results Compared with suture group,SHVC reconstruction time,anhepatic phase and recipient operation time were significantly decreased inrings group〔SHVC reconstruction time(min):0.91±0.24 vs. 10.4±2.11,anhepatic phase time(min):5.63±0.65 vs. 17.76±2.51,recipient operation time(min):36.02±8.02 vs. 49.38±12.06,all P < 0.05〕. In the rings group,29 rats survived for 7 days and 28 rats survived for 30 days. In contrast,only 25 recipients in suture group remained alive for 7 days and 22 survived for more than 30 days(P < 0.05). Conclusion Better anastomotic healing was founded in rings group by pathology and electron microscope scan. The magnetic rings technique provides a novel,simple method for SHVC reconstruction of orthotopic liver transplantation(OLT)in rat. It significantly shortens anhepatic phase,while the success rate of the operation is satisfactory