Small bowel transplantation in rats, A multicenter experience summarizing the pitfalls to be overcome

Abstract

Small Bowel transplantation in rats is a highly complex microsurgical procedure because several technical complications may lead to recipient mortality and transplant failure. Our aim was to report the most common complications associated with orthotopic and heterotopic intestinal transplantation in rats in order to identify the "pitfalls" of the procedure and prevent them. A retrospective multicenter study was performed. All participant centers have established rodent transplant procedures and trained surgeons. Two hundred ninety-three complications from 264 unsuccessful intestinal transplants were reported, representing an overall failure rate of 15% of the procedures performed. Recipient complications were most frequent than donor (257 vs. 36 p<0.0001). Excessive surgical time (11/36); severe hemorrhage (12/36) and inappropriate infusion of the preservation solution in the intestinal graft (11/36) were the most common donor complications. Arterial anastomosis bleeding (50/257), venous anastomosis bleeding (35/257) and portal vein stenosis (26/257) were the most common intraoperative complications in the recipient. To maximize success rate, surgeons should optimize time and avoid bleeding during graft dissection in the donor surgery. After performing a bloodless vascular anastomosis an adequate post-operative management of the animal is mandatory to guarantee survival.

Modified Multivisceral Transplantation with Native Spleen Removal in Rats

“…Due to the limited evidence in experimental models of MMVTx in rats, 7 we have used our previous experience in rodents experimental surgery and the extensive literature published in isolated small bowel and multivisceral transplantation to transfer to our heterotopic MMVTx model as well as pre-and post-surgical animal handling, anesthetics, analgesics, and antibiotics, with a very good effectiveness. 8,9,[15][16][17][18][19][20] Focusing on vascular anastomosis, we performed an end-to-side arterial anastomosis between the donor and recipient aorta following the technique reported by Galvao et al In contrast, due to the heterotopic graft position, we performed a hand-to-sewn venous anastomosis between donor PV and recipient cava vein instead of the described cuff technique. 7 In agreement with the multicenter work published by our surgeons group in isolated intestinal transplantation in rats, 8 main complications observed during recipient MMVTx surgery were related to the arterial and venous anastomosis confection.…”