En bloc kidney and whole pancreaticoduodenal transplantation with bladder drainage in the rat: Microsurgical technique and outcome

Abstract

A microsurgical technique for en bloc kidney and whole pancreaticoduodenal transplantation with bladder drainage employing triple vascular anastomoses without the need for a vascular cuff is described. Nineteen combined isografts were performed using this technique in inbred male Lewis (RT1:I) rats with streptozotocin-induced diabetes. Six recipients died within 1 month from early complications (two from uremia, two from pancreatitis, one from bleeding, one from peritonitis); the other 13 survived more than 1 month after transplantation with both the pancreas and kidney grafts functioning. Four of the 13 rats died after 1 month (one from uremia secondary to an obstructed ureter, one from unexplained uremia, one from peritonitis after a biopsy, and one of unknown causes). The pancreas isografts of two animals were excised at 1 and 3 months to confirm dependence on the graft; both animals became hyperglycemic after graft pancreatectomy and had immediate declines of urine amylase activity to normal. One animal was sacrificed at 3 months to determine the insulin content of its native and transplanted pancreas; insulin was very low in the former and normal in the latter. The remaining rats survived with both grafts functioning for at least 6 months (normoglycemic, high urinary amylase levels, normal or near-normal plasma creatinine concentrations), before being sacrificed within the context of other experiments and for histological observations. Both the kidney and pancreas isografts were well preserved microscopically.(ABSTRACT TRUNCATED AT 250 WORDS)

Review of Various Techniques of Pancreas Transplantation in Rat Model

“…However, some studies showed that PTx with enteric diversion of the exocrine graft secretion part is more prone to intestinal bleeding and ileus and increases the chance of bacterial contamination because of the bowel opening [19]. The urinary diversion of the exocrine part of the graft has some benefits over the enteric one such as avoiding opening of the recipient bowel and minimization of bacterial contamination, direct monitoring of the pancreas for rejection, as well as lesser morbidity of anastomotic leaks from urinary anastomosis [10]. However, dehydration and acidosis, recurrent urinary tract infections, reflux graft pancreatitis, and hematuria with the occasional need for conversion to the enteric drainage are some disadvantages of urinary exocrine drainage [11].…”

“…The current preferred method for rearterialization is the microsuture technique, which provides an anastomosis more similar to the physiological setting. Although the use of cuff technique has simplified the arterial anastomosis and decreased complications associated with the microsuture technique by means of reduction in warm ischemia time and thrombosis [9], its high rate of technical failure [10] reduces its acceptance among surgeons (Table 1).…”

“…For example, it is reported that the portal venous drainage anastomosis mean ischemia time is shorter than the systemic one [6], which can explain the lower rate of complications in this method. Additionally, in the porto-systemic venous drainage, the portal vein tends to kink when anastomosed to the recipient's inferior vena cava [10]. Technical failures of anastomoses are probably the most important cause of deaths in rat PTx [26].…”

Simultaneous Pancreaticoduodenal-Kidney Transplantation in Rats

“…PDKTs in rats were first described by Nakai et al [2]in 1993. It lasted 6 years until Lee et al [1]repeated the model.…”

“…Rats have been widely used in transplantation models because of their low cost and the opportunity to manipulate immune responses by selecting inbred and outbred strain combinations. It is a difficult problem to build a small-animal model with combined pancreaticoduodenal-kidney transplantation (PDKT) because of complex surgical technique [1, 2]. In our study, we performed two ‘cuff’ anastomoses [3]to converge donor portal vein and left kidney vein into the inferior vena cava (IVC) together and to overcome donor venous outflow in two directions.…”