Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol

Abstract

Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease. It offers better life expectancy and higher quality of life when compared to dialysis. Although the last few decades have seen major improvements in patient outcomes following kidney transplantation, the increasing shortage of available organs represents a severe problem worldwide. To expand the donor pool, marginal kidney grafts recovered from extended criteria donors (ECD) or donated after circulatory death (DCD) are now accepted for transplantation. To further improve the postoperative outcome of these marginal grafts, research must focus on new therapeutic approaches such as alternative preservation techniques, immunomodulation, gene transfer, and stem cell administration.Experimental studies in animal models are the final step before newly developed techniques can be translated into clinical practice. Porcine kidney transplantation is an excellent model of human transplantation and allows investigation of novel approaches. The major advantage of the porcine model is its anatomical and physiological similarity to the human body, which facilitates the rapid translation of new findings to clinical trials. This article offers a surgical step-by-step protocol for an autotransplantation model and highlights key factors to ensure experimental success. Adequate pre-and postoperative housing, attentive anesthesia, and consistent surgical techniques result in favorable postoperative outcomes. Resection of the contralateral native kidney provides the opportunity to assess post-transplant graft function. The placement of venous and urinary catheters and the use of metabolic cages allow further detailed evaluation. For long-term follow-up studies and investigation of alternative graft preservation techniques, autotransplantation models are superior to allotransplantation models, as they avoid the confounding bias posed by rejection and immunosuppressive medication. Video LinkThe video component of this article can be found at

Normothermic ex vivo kidney perfusion for graft quality assessment prior to transplantation

“…14 30-kg pigs were assigned to 3 different groups: noninjured, healthy grafts were used in group A; 30 minutes of warm ischemia (WI, moderate injury) was applied in group B; and 60 minutes of WI (severe injury) was applied in group C. After a 4°C cold flush with histidine-tryptophan-ketoglutarate solution, all grafts were perfused at 37°C (normothermic ex vivo kidney perfusion [NEVKP]). 14 30-kg pigs were assigned to 3 different groups: noninjured, healthy grafts were used in group A; 30 minutes of warm ischemia (WI, moderate injury) was applied in group B; and 60 minutes of WI (severe injury) was applied in group C. After a 4°C cold flush with histidine-tryptophan-ketoglutarate solution, all grafts were perfused at 37°C (normothermic ex vivo kidney perfusion [NEVKP]).…”

“…Kidney retrieval was performed as previously described. 14 30-kg pigs were assigned to 3 different groups: noninjured, healthy grafts were used in group A; 30 minutes of warm ischemia (WI, moderate injury) was applied in group B; and 60 minutes of WI (severe injury) was applied in group C. After a 4°C cold flush with histidine-tryptophan-ketoglutarate solution, all grafts were perfused at 37°C (normothermic ex vivo kidney perfusion [NEVKP]). After preservation, grafts were cold flushed for transplantation and reperfused, and animals were followed for 3 days [Color figure can be viewed at wileyonlinelibrary.com] incision was performed for dissection of the right kidneys and clamping of the renal vein and artery, in case WI was applied (groups B and C).…”

Extra‐corporeal normothermic machine perfusion of the porcine kidney: working towards future utilization in Australasia

“…In the second set of experiments, kidneys ( n = 6) were retrieved from Westran pigs using a DCD model (based on the methods of Kaths et al S2).…”

Ethics in Solid Organ Transplantation

“…22 Zatim su postupno otkrivani imunosupresivni postupci i lijekovi pa je nekad nezamisliva koegzistencija organa jedne jedinke u drugoj danas sasvim rutinska, a čini se da nam se u ne tako dalekoj budućnosti smiješe i humani organi uzgojeni u drugoj (životinjskoj) vrsti. 23 Današnje etičke dvojbe tako već mogu anticipirati buduće. Hoće li one uslijediti postupno ili se nećemo snaći u njihovoj eksploziji, teško je predvidjeti.…”