Questo lavoro è stato sostenuto in parte da 1R03DK096151.

Tutti i topi sono stati acquistati da The Jackson Laboratory (Bar Harbor, ME), e sono stati alloggiati in condizioni di libero patogeni presso l&#39;Università del Colorado Denver, Facility Barbara Davis Animal Center secondo Linee Guida NIH e con l&#39;approvazione della University of Colorado Denver IACUC. 1. Trapianto renale Harvest <ol><li> Sterilizzare tutti gli strumenti, indossare guanti sterili durante tutta la procedura e mantenere un campo sterile. Eseguire tutti gli interventi chirurgici con l&#39;uso di un microscopio operatorio. </li><li> Rimuovere chirurgicamente reni topo donatore da (kg IP 60mg /) donatori pentobarbital-anestetizzati. Accertare profondità dell&#39;anestesia da punta pizzico, e osservare la frequenza respiratoria. </li><li> Agganciare la pelliccia quindi immobilizzare il mouse da vincoli a 4 vie. Preparare la pelle con iodio-povidone e drappeggio il mouse in modo sterile. </li><li> Fare un 2 centimetri linea mediana verticale incisione addominale e entrare nella cavità addominale. Ritrarre l&#39;intestino superiormente ed esternare laal petto. Mantenere l&#39;intestino avvolto in una garza sterile umido durante tutta la procedura. </li><li> Identificare i grossi vasi addominali e mobilitare, identificare eventuali rami lombari e sia cauterizzare o legare con 10/0 sutura in nylon. </li><li> Immediatamente distale vasi renali sinistra stuzzicare la vena cava inferiore (IVC) e aorta addominale (AA) a parte per via smussa su circa 2mm. Legare con 10/0 nylon e dividere piccolo arterioso e rami venosi dai vasi renali. </li><li> Ora separare la vena renale dalla arteria renale attentamente per via smussa di queste strutture. Questo consente la creazione accurata di una patch Carrel all&#39;estremità prossimale della vena renale, che verrà utilizzata per formare una anastomosi end-to-side ai destinatari IVC. </li><li> Identificare, legare e sezionare i vasi surrenali sinistra. Questo consente l&#39;accesso all&#39;aorta surrenale e una sutura di seta 6-0 è collocato intorno l&#39;aorta in preparazione per legatura, ma non legato in questo momento. </li&gt; <li> Mobilitare il rene, i vasi e dell&#39;uretere dalla plancia circostante. Ruotare il rene a destra e legare / dividere i rami posteriori. Quindi tornare il rene di sinistra. </li><li> Ora dirigere l&#39;attenzione per l&#39;uretere. Senza scomodare l&#39;ilo renale liberare l&#39;uretere dal circostante plancia facendo attenzione a preservare i vasi ureterali. Dividere l&#39;uretere a livello del dotto deferente. Il rene è ora pronto per il recupero. </li><li> Iniettare lentamente 300 unità di eparina nel distale IVC heparinizing così il donatore. Fissare la sutura di seta 6-0 disposte intorno al AA surrenale e profumato rene sinistro tramite l&#39;aorta addominale distale con 0.8ml di soluzione di eparina salina (100 U / ml). </li><li> Una volta che la perfusione ha cessato creare una patch Carrel venoso immediatamente per eliminare il riflusso nel rene. Ritrarre la vena renale verso il rene rivelando l&#39;AA e dell&#39;arteria renale sotto. </li><li> Dividere l&#39;aorta adiacente dell&#39;arteria renale creando un tacco ee bracciale come mostrato in Figura 1. Rimuovere i reni, vasi e dell&#39;uretere dal donatore. </li><li> Rimuovere il rene direttamente a un destinatario pre-preparati (0 min tempo di ischemia fredda) o conservati a 4 ° C in una soluzione di scelta per un tempo predeterminato fino al momento dell&#39;impianto. Eutanasia donatori di exsanguanation e dislocazione cervicale. Il tempo totale per il recupero del rene del donatore è di circa. 15-20 min. </li></ol> 2. Rene tecnica di impianto <ol><li> Anestetizzare il mouse destinatario con pentobarbital (60 mg / kg IP dose iniziale, 25 mg dose supplementare / kg IP se richiesto). Accertare profondità dell&#39;anestesia da punta pizzico, e osservare la frequenza respiratoria. Clip della pelliccia quindi immobilizzare il mouse da vincoli a 4 vie e applicare pomata oftalmica per gli occhi. Preparare la pelle con iodio-povidone e drappeggio il mouse in modo sterile. </li><li> Fare un 2 centimetri linea mediana verticale incisione addominale e entrare nella cavità addominale. Ritrarre l&#39;intestinosuperiormente e externalize al petto. Mantenere l&#39;intestino avvolto in una garza sterile umido durante tutta la procedura. </li><li> A questo punto eseguire una nefrectomia destra. Legare l&#39;arteria e la vena renale con 6-0 punti di sutura in seta. Accise distale rene per le suture. Legare l&#39;uretere con 6-0 seta e poi dividere prossimale al rene. </li><li> Isolare l&#39;aorta addominale e vena cava inferiore (IVC) sotto i vasi renali. Mettere 4-0 legami di cotone attorno l&#39;aorta e vena cava inferiore superiore poi inferiore al sito anastomosi. Identificare e legare eventuali vasi lombari all&#39;interno del campo con 10-0 sutura in nylon. </li><li> Annodare i legami di cotone, prima l&#39;inferiore, seguito dal superiore. In questo modo viene mantenuta del sangue nell&#39;aorta rendendo il aortotomy facile. </li><li> Formare la aortotomy con un ago 30G per entrare nel lume dell&#39;aorta. Estendere l&#39;incisione con sottili forbici micro ad una lunghezza di circa 2 mm. </li><li> Effettuare la fine anastomosi lato della cuffia aortico donatore tacco e punta al&#39;aorta destinatario nel seguente modo. Inserire un 10-0 nylon soggiorno suture stitch nell&#39;aorta donatore e all&#39;angolo inferiore dell&#39;incisione nell&#39;aorta destinatario e cravatta. </li><li> Posizionare un secondo 10-0 nylon opposto al primo nell&#39;aorta donatore e l&#39;angolo superiore dell&#39;incisione in aorta addominale e cravatta. Fare una linea sutura continua da superiore a inferiore nella parete laterale dell&#39;aorta e legare contro la permanenza punto precedentemente posizionato. Poi suturare la parete mediale in modo esecuzione e cravatta. </li><li> Effettuare la fine anastomosi lato della vena renale donatore al ricevente IVC nel seguente modo. Forare il IVC con un ago 30G ed estendere l&#39;incisione con sottili forbici micro. Legare la vena renale donatore verso l&#39;angolo inferiore della incisione nel IVC con 10-0 di nylon. Fare una linea di sutura che corre tra la vena renale e l&#39;IVC e cravatta. NOTA: E &#39;di vitale importanza che tutto spessore passa l&#39;ago di sutura tra cui il adventit vascolareia e l&#39;intima sono raggiunti. Eversion dei bordi assicura anche che c&#39;è intima-to-intima contatto, che aiuta nella chiusura e guarigione delle anastomosi. Mentre un agente di coagulazione emostatico può essere utile per ridurre le perdite, si raccomanda che un chirurgo invece contare su una buona tecnica. </li><li> Assicurarsi che le anastomosi sono &quot;puliti&quot;. Vale a dire, che le pareti opposte, non sono catturati durante il posizionamento di punti. Questo provocherà un restringimento significativo di fluire che si tradurrà in un innesto fallito e, in casi estremi arto posteriore paralisi. NOTA: Un altro fattore estremamente importante è garantire che la tensione delle linee di sutura anastomotica anche ottimale. Troppo lenta e non ci saranno perdite irreversibili, troppo stretto e stenosi di fluire si tradurrà. Se sul lato arterioso questo si tradurrà in scarsa perfusione dell&#39;innesto, se sul lato venoso comporterà un rene congestionata. </li><li> Rilasciare il distale flusso venoso 4-0 cotone tie ristabilire. Una volta emostasi del venonoi anastomosi è stata osservata gradualmente allentare la prossimale pareggio 4-0 in cotone e osservare la anastomosi arteriosa per l&#39;emostasi. </li><li> Rimuovere le fascette di cotone dal mouse una volta entrambe le anastomosi sono considerati sicuri. Pierce vescica con un ago 20 G creando due fori. </li><li> Far passare la punta delle pinze curve attraverso i fori e tirare l&#39;uretere donatore attraverso la vescica con la pinza con l&#39;estremità prossimale dell&#39;uretere essere ancorato alla parete della vescica con due 10-0 suture in nylon. Tagliare la lunghezza in eccesso dell&#39;uretere sporge dal secondo foro permettendo l&#39;uretere ritragga all&#39;interno della vescica e chiudere il foro con due 10-0 suture in nylon. </li><li> Ritorna l&#39;intestino all&#39;addome. Chiudere la parete addominale in due strati con 5-0 sutura di seta in modo esecuzione. </li><li> Somministrare un bolo 1,0 ml di soluzione sterile, caldo normale soluzione fisiologica nell&#39;addome come rianimazione fluido alla chiusura, e iniettare 0,8 ml di soluzione fisiologica normale per via sottocutanea nel post-operatorio. Nessun altro Supportigiocare cinque misure durante l&#39;intervento sono obbligatori. </li><li> Recuperare l&#39;animale su una coperta di riscaldamento. Tempo totale dell&#39;impianto è di circa. 35-45 min. Somministrare analgesici come buprenorfina, 0,05 mg / kg, SC, 0,1-0,2 ml all&#39;inizio della procedura e ogni 6-12 ore per 72 ore post-op. </li></ol> 3. controlaterale Nefrectomia <ol><li> A seconda dei requisiti di protocollo, diversi giorni dopo la procedura di impianto, eseguire una nefrectomia controlaterale sotto anestesia isoflurano (5% isoflurano inalato per induzione, 1,5-2,0% per la manutenzione). </li><li> Inserire la cavità addominale e ritrarre delicatamente l&#39;intestino al diritto degli animali. Esporre il rene sinistro e sezionare smussato dalla fascia circostanti. </li><li> Legare l&#39;arteria renale, vena e dell&#39;uretere con 6-0 punti di sutura in seta e poi asportare il rene sopra le suture e rimuovere il rene. Tempo operatorio totale è di circa. 10 min. </li></ol> 4. Graft Assessment <ol><li> Misura siero Creatinove utilizzando il metodo del picrato alcalino (reazione Jaffe). </li></ol>

<ol>
	<li>Skoskiewicz, M., Chase, C., Winn, H. J., Russell, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kidney+transplants+between+mice+of+graded+immunogenetic+diversity.">Kidney transplants between mice of graded immunogenetic diversity.</a> Transplant Proc. 5 (1), 721-725 (1973).</li><li>Kalina, S. L., Mottram, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+microsurgical+technique+for+renal+transplantation+in+mice.">A microsurgical technique for renal transplantation in mice.</a> Aust N Z J Surg. 63 (3), 213-216 (1993).</li><li>Han, W. R., Murray-Segal, L. J., Mottram, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+technique+for+kidney+transplantation+in+mice.">Modified technique for kidney transplantation in mice.</a> Microsurgery. 19 (6), 272-274 (1999).</li><li>Ge, F., Gong, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Strategies+for+successfully+establishing+a+kidney+transplant+in+a+mouse+model.">Strategies for successfully establishing a kidney transplant in a mouse model.</a> Exp Clin Transplant. 9 (5), 287-294 (2011).</li><li>Martins, P. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+curve,+surgical+results+and+operative+complications+for+kidney+transplantation+in+mice.">Learning curve, surgical results and operative complications for kidney transplantation in mice.</a> Microsurgery. 26 (8), 590-593 (2006).</li><li>Corry, R. J., Winn, H. J., Russell, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primarily+vascularized+allografts+of+hearts+in+mice.+The+role+of+H-2D,+H-2K,+and+non-H-2+antigens+in+rejection.">Primarily vascularized allografts of hearts in mice. The role of H-2D, H-2K, and non-H-2 antigens in rejection.</a> Transplantation. 16 (4), 343-350 (1973).</li><li>Zhang, Z., Chen, H., Qian, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kidney+Transplantation+in+Mice.">Kidney Transplantation in Mice.</a> Experimental Organ Transplantation. , 45-64 (2013).</li><li>Zhang, L., Moskovitz, M., Piscatelli, S., Longaker, M. T., Siebert, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamic+study+of+different+angled+end-to-side+anastomoses.">Hemodynamic study of different angled end-to-side anastomoses.</a> Microsurgery. 16 (2), 114-117 (1995).</li><li>Liu, Q., Mirc, D., Fu, B. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+mechanisms+of+thrombosis+in+intact+bent+microvessels+of+rat+mesentery.">Mechanical mechanisms of thrombosis in intact bent microvessels of rat mesentery.</a> J Biomech. 41 (12), 2726-2734 (2008).</li><li>Chesnutt, J. K., Han, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tortuosity+triggers+platelet+activation+and+thrombus+formation+in+microvessels.">Tortuosity triggers platelet activation and thrombus formation in microvessels.</a> J Biomech Eng. 133 (12), 121004 (2011).</li><li>Han, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+vessel+buckling+within+soft+surrounding+tissue+generates+tortuosity.">Blood vessel buckling within soft surrounding tissue generates tortuosity.</a> J Biomech. 42 (16), 2797-2801 (2009).</li><li>Gutierrez-Diaz, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraluminal+thrombus+and+neointimal+hyperplasia+after+microvascular+surgery.">Intraluminal thrombus and neointimal hyperplasia after microvascular surgery.</a> Surg Neurol. 24 (2), 153-159 (1985).</li><li>Khouri, R. K., Cooley, B. C., Kenna, D. M., Edstrom, L. 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The authors have nothing to disclose.

Padroneggiare questa tecnica di trapianto è difficile, ma una volta realizzato, è uno strumento di ricerca molto potente. Il paziente chirurgo / ricercatore sarà ricompensato dalla cura dei dettagli e la coerenza della tecnica, che è la chiave per padroneggiare qualsiasi procedura chirurgica, a maggior ragione nei piccoli modelli animali. Le difficoltà tecniche di padroneggiare il trapianto di rene di topo sono molte pieghe, ed è molto probabile che l&#39;esperienza in altri modelli di piccole dimensioni trapianto...

Dal 1973 il modello di trapianto di rene nei topi è stato un valido strumento di ricerca, ma problemi tecnici hanno ostacolato la sua diffusione. Nel corso degli anni numerosi lavori sono stati pubblicati in dettaglio i miglioramenti / perfezionamenti a questa procedura. Come modello di principalmente vascolarizzato trapianto di organo solido questa procedura è probabilmente secondo solo al modello di trapianto di cuore eterotopico che è stato anche ideato dal laboratorio di Russell nel 1973 6. Entrambi i modelli si prestano alla ricerca sulle risposte di rigetto allogenico, lo sviluppo di ritardata funzionalità del trapianto e danno da ischemia riperfusione. Uno dei problemi più comuni da segnalare con trapianto renale è relativamente alta incidenza di trombosi arteriosa 4,5,7 che abbiamo anche sperimentato nel nostro laboratorio. Pertanto abbiamo deciso di effettuare una revisione della letteratura di formazione di trombi e forse trovare la causa di questo problema tecnico e di elaborare anche unapossibile soluzione. La causa più probabile di trombosi è il percorso alquanto tortuosa sangue prende dall&#39;aorta destinatario, nell&#39;aorta renale donatore poi all&#39;arteria renale donatore. Questo percorso provoca turbolenza nella arteria renale che può portare all&#39;attivazione delle piastrine e formazione di trombi. Sulla base delle recenti osservazioni e una ricerca di letteratura 8-14 siamo arrivati ​​a una nuova tecnica che ha ridotto la trombosi a 0%. La tecnica qui descritta varia da tecniche precedentemente riportati nella formazione di un bracciale tallone e punta arteriosa che strutture migliorate flusso sanguigno e riduce notevolmente la formazione di trombi. Il polsino è formata dividendo dell&#39;aorta infra-renale attraverso la faccia della ostio arterioso renale con un angolo inferiore a 45 ° rispetto all&#39;asse longitudinale dell&#39;aorta (Figura 1A e 1B). Ciò si traduce in un bracciale circa 2mm di lunghezza. Una patch Carrel venoso è formata da sezionare la rvena Enal nella IVC aumentando il diametro del bracciale. Il donatore addominale dell&#39;aorta polsino tacco e punta infra-renale è end-to-side anastomizzata all&#39;aorta addominale destinatario e la vena renale donatore / patch IVC è end-to-side anastomizzata al destinatario addominale vena cava inferiore (IVC) . L&#39;uretere viene poi introdotto in ed ancorata alla vescica come descritto da Han et al 3. Per questo studio i trapianti non trattati con soli tempi di ischemia calda (es., Senza di ischemia fredda) si confrontano. In questo caso ischemia calda si riferisce al tempo dalla cessazione del flusso di sangue attraverso il rene donatore (passo 1.11) e riperfusione del graft nel ricevente (passo 2.11 sotto). Ischemia fredda si riferisce al tempo che il rene non è perfuso e si mantiene in celle frigorifere fino all&#39;inizio della procedura di impianto.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Instrument</td>
			<td>Roboz #</td>
			<td>Fine Science Tools #</td>
			<td>Arosurgical #</td>
		</tr>
		<tr>
			<td>Straight micro-dissecting forcep #5</td>
			<td>RS-5015</td>
			<td>11295-51</td>
			<td></td>
		</tr>
		<tr>
			<td>Curved micro-dissecting forcep #7</td>
			<td>RS-5047</td>
			<td>11297-00</td>
			<td></td>
		</tr>
		<tr>
			<td>Curved serrated forcep</td>
			<td>RS-5137</td>
			<td>11052-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Vannas micro-dissecting scissors, short</td>
			<td>RS-5610</td>
			<td></td>
			<td>09.140.08</td>
		</tr>
		<tr>
			<td colspan="2">Micro-dissecting scissors, straight, sharp, long</td>
			<td></td>
			<td>11.602.11</td>
		</tr>
		<tr>
			<td>Micro spring handle needle holder</td>
			<td></td>
			<td></td>
			<td>11.549.15</td>
		</tr>
		<tr>
			<td>Straight mosquito forcep</td>
			<td></td>
			<td>91308-12</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro-dissecting scissors, straight, blunt</td>
			<td>RS-5962</td>
			<td>14078-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro-dissecting scissors, curved, blunt</td>
			<td>RS-5981</td>
			<td>14079-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro retractor</td>
			<td>RS-6540</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Instrument tray, 10&#8221; x 6 &#189;&#8221; x &#190;&#8221;</td>
			<td>RT-1350S</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Silk suture, 5/0, 22.5m spool</td>
			<td></td>
			<td>18020-50</td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Suture</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>10/0 nylon</td>
			<td></td>
			<td></td>
			<td>T4A10Q07</td>
		</tr>
		<tr>
			<td>5/0 silk</td>
			<td></td>
			<td></td>
			<td>E19A05N</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Gloves</td>
			<td></td>
			<td>Drapes</td>
			<td></td>
		</tr>
		<tr>
			<td>Biogel from Medex Supply</td>
			<td></td>
			<td>Precept, #64-9012-9</td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Syringes</td>
			<td></td>
			<td>Cotton applicators</td>
			<td></td>
		</tr>
		<tr>
			<td>B-D 1cc insulin, #329424</td>
			<td></td>
			<td colspan="2">Fisher-brand, #23-400-100</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Povidone-Iodine swabs</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PDI, #B40600</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>4/0 Cotton ties</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td colspan="2">Domestic cotton autoclaved with instruments</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

murine kidney transplant technique

The first mouse kidney transplant technique was published in 19731 by the Russell laboratory. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique using the donor aorta to form the arterial anastomosis instead of the renal artery was developed and reported in 1993 by Kalina and Mottram 2 with a further advancement coming from the same laboratory in 1999 3. While one can become proficient in this model, a search of the literature reveals that many labs still experience a high proportion of graft loss due to arterial thrombosis. We describe here a technique that was devised in our laboratory that vastly reduces the arterial thrombus reported by others 4,5. This is achieved by forming a heel-and-toe cuff of the donor infra-renal aorta that facilitates a larger anastomosis and straighter blood flow into the kidney.

Questa tecnica chirurgica consente sia per i semplici studi di sopravvivenza / rigetto dell&#39;organo o protocolli sperimentali piuttosto complessi. Nelle figure di seguito dimostriamo i vantaggi di utilizzare questo miglioramento tecnica anastomosi arteriosa. Utilizzando questa tecnica abbiamo ridotto significativamente l&#39;incidenza di trombosi arteriosa dal 35% allo 0%, aumentando così la produttività. Abbiamo usato questa tecnica per oltre un anno con lo stesso risultato trombosi 0% mantenuto. ...

Watch this Scientific Journal Video about Murine Kidney Transplant Technique at JoVE.com

Murine Kidney Transplant Technique

The goal of this manuscript is to describe the steps required to perform a kidney transplant in a mouse, paying particular attention to the details of the arterial anastomosis.

Rene Murine Tecnica trapianto

The first mouse kidney transplant technique was published in 19731 by the Russell laboratory. Although it took some years for other labs to become ...

Research

JoVE Journal

Medicine

15.8K Views.  University of Colorado, Denver. The goal of this manuscript is to describe the steps required to perform a kidney transplant in a mouse, paying particular attention to the details of the arterial anastomosis. 

Video: Murine Kidney Transplant Technique

A Method for Murine Islet Isolation and Subcapsular Kidney Transplantation

Since the early pioneering work of Ballinger and Reckard demonstrating that transplantation of islets of Langerhans into diabetic rodents could normalize their blood glucose levels, islet transplantation has been proposed to be a potential treatment for type 1 diabetes 1,2. More recently, advances in human islet transplantation have further strengthened this view 1,3. However, two major limitations prevent islet transplantation from being a widespread clinical reality: (a) the requirement for large numbers of islets per patient, which severely reduces the number of potential recipients, and (b) the need for heavy immunosuppression, which significantly affects the pediatric population of patients due to their vulnerability to long-term immunosuppression. Strategies that can overcome these limitations have the potential to enhance the therapeutic utility of islet transplantation.
Islet transplantation under the mouse kidney capsule is a widely accepted model to investigate various strategies to improve islet transplantation. This experiment requires the isolation of high quality islets and implantation of islets to the diabetic recipients. Both procedures require surgical steps that can be better demonstrated by video than by text. Here, we document the detailed steps for these procedures by both video and written protocol. We also briefly discuss different transplantation models: syngeneic, allogeneic, syngeneic autoimmune, and allogeneic autoimmune.

Transplantation of isolated islets has been proposed to be a potential treatment for type 1 diabetes. Here we describe a method to isolate islets from mouse pancreata and transplant them to the subcapsular space of the kidney.

Un metodo per isolamento Islet murini e trapianto renale subcapsulare

Since the early pioneering work of Ballinger and Reckard demonstrating that transplantation of islets of Langerhans into diabetic rodents could normalize ...

Ricerca

Medicina

Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice1-3. This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates4.
Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient5.
Herein, we provide additional details of this technique to supplement the video.

The murine cervical heart transplantation model is well suited for immunological as well as ischemia reperfusion injury studies. We modified the procedure using a non-suture cuff technique and performed more than 1,000 successful transplants with this approach.
Herein, we provide additional details of this technique to supplement the video.

Murino cervicale Cuore trapianto Modello utilizzando una tecnica Cuff Modificato

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are ...

Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

The success of liver transplantation has resulted in a dramatic organ shortage. In most transplant regions 20-30% of patients on the waiting list for liver transplantation die without receiving an organ transplant or are delisted for disease progression. One strategy to increase the donor pool is the utilization of marginal grafts, such as fatty livers, grafts from older donors, or donation after cardiac death (DCD). The current preservation technique of cold static storage is only poorly tolerated by marginal livers resulting in significant organ damage. In addition, cold static organ storage does not allow graft assessment or repair prior to transplantation.
These shortcomings of cold static preservation have triggered an interest in warm perfused organ preservation to reduce cold ischemic injury, assess liver grafts during preservation, and explore the opportunity to repair marginal livers prior to transplantation. The optimal pressure and flow conditions, perfusion temperature, composition of the perfusion solution and the need for an oxygen carrier has been controversial in the past.
In spite of promising results in several animal studies, the complexity and the costs have prevented a broader clinical application so far. Recently, with enhanced technology and a better understanding of liver physiology during ex vivo perfusion the outcome of warm liver perfusion has improved and consistently good results can be achieved.
This paper will provide information about liver retrieval, storage techniques, and isolated liver perfusion in pigs. We will illustrate a) the requirements to ensure sufficient oxygen supply to the organ, b) technical considerations about the perfusion machine and the perfusion solution, and c) biochemical aspects of isolated organs.

Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts

Marginal grafts, such as fatty livers, grafts from older donors, or livers retrieved after cardiac death (DCD) tolerate conventional, cold static storage only poorly. We developed a novel model of subnormothermic ex vivo liver perfusion for preservation, assessment, and repair of marginal liver grafts prior to transplantation.

Tecnica di Subnormothermic<em&gt; Ex Vivo</em&gt; Fegato perfusione per la Conservazione, valutazione e riparazione dei marginali fegato innesti

The success of liver transplantation has resulted in a dramatic organ shortage. In most transplant regions 20-30% of patients on the waiting list for ...

Murine Heterotopic Heart Transplant Technique

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become proficient in and utilize this technique, it is now widely used by many laboratories around the world. A significant refinement to the original technique was developed and reported in 2001 by Niimi. Described here are the techniques that have evolved over more than a decade in the hands of three surgeons (Plenter, Grazia, Pietra) in our center. These techniques are now being passed on to a younger generation of surgeons and researchers.
Based largely on the Niimi experience, the procedures used have evolved in the fine details - details which we will endeavor to relate here in such a way that others may be able to use this very useful model. Like Niimi, we have found that a video aid to learning is a priceless resource for the beginner.

The manuscript describes the steps required to perform the heterotopic heart transplant in the mouse.

Murini eterotopica cuore Tecnica Trapianto

It is now over forty years since this technique was first reported by Corry, Wynn and Russell. Although it took some years for other labs to become ...

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

The success of liver transplantation has resulted in a dramatic organ shortage. Each year, a considerable number of patients on the liver transplantation waiting list die without receiving an organ transplant or are delisted due to disease progression. Even after a successful transplantation, rejection and side effects of immunosuppression remain major concerns for graft survival and patient morbidity. 
Experimental animal research has been essential to the success of liver transplantation and still plays a pivotal role in the development of clinical transplantation practice. In particular, the porcine orthotopic liver transplantation model (OLTx) is optimal for clinically oriented research for its close resemblance to human size, anatomy, and physiology. 
Decompression of intestinal congestion during the anhepatic phase of porcine OLTx is important to guarantee reliable animal survival. The use of an active porto-caval-jugular shunt achieves excellent intestinal decompression. The system can be used for short-term as well as long-term survival experiments. The following protocol contains all technical information for a stable and reproducible liver transplantation model in pigs including post-operative animal care.

Experimental animal research plays a pivotal role in the development of clinical transplantation practice. The porcine orthotopic liver transplantation model (OLTx) closely resembles human conditions and is frequently used in clinically oriented research. The following protocol contains all information for a reliable porcine OLTx model using an active porto-caval-jugular shunt.

Tecnica di Suini appalti Fegato e trapianto ortotopico con un attivo Porto-Caval Shunt

The success of liver transplantation has resulted in a dramatic organ shortage. Each year, a considerable number of patients on the liver transplantation ...

Mouse Model of Alloimmune-induced Vascular Rejection and Transplant Arteriosclerosis

Vascular rejection that leads to transplant arteriosclerosis (TA) is the leading representation of chronic heart transplant failure. In TA, the immune system of the recipient causes damage of the arterial wall and dysfunction of endothelial cells and smooth muscle cells. This triggers a pathological repair response that is characterized by intimal thickening and luminal occlusion. Understanding the mechanisms by which the immune system causes vasculature rejection and TA may inform the development of novel ways to manage graft failure. Here, we describe a mouse aortic interposition model that can be used to study the pathogenic mechanisms of vascular rejection and TA. The model involves grafting of an aortic segment from a donor animal into an allogeneic recipient. Rejection of the artery segment involves alloimmune reactions and results in arterial changes that resemble vascular rejection. The basic technical approach we describe can be used with different mouse strains and targeted interventions to answer specific questions related to vascular rejection and TA.

We describe a protocol for aortic interposition grafting in mice. The goal of the protocol is to provide a model with which to study pathological processes and therapeutic strategies relevant to alloimmune reactions in arteries and the resultant arterial changes that contribute to organ transplant failure.

Modello murino della alloimmune indotta Rifiuto vascolare e trapianto Arteriosclerosi

Vascular rejection that leads to transplant arteriosclerosis (TA) is the leading representation of chronic heart transplant failure. In TA, the immune ...

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation

Kidney transplantation has become a well-established treatment option for patients with end-stage renal failure. The persisting organ shortage remains a serious problem. Therefore, the acceptance criteria for organ donors have been extended leading to the usage of marginal kidney grafts. These marginal organs tolerate cold storage poorly resulting in increased preservation injury and higher rates of delayed graft function. To overcome the limitations of cold storage, extensive research is focused on alternative normothermic preservation methods.
Ex vivo normothermic organ perfusion is an innovative preservation technique. The first experimental and clinical trials for ex vivo lung, liver, and kidney perfusions demonstrated favorable outcomes.
In addition to the reduction of cold ischemic injury, the method of normothermic kidney storage offers the opportunity for organ assessment and repair. This manuscript provides information about kidney retrieval, organ preservation techniques, and isolated ex vivo normothermic kidney perfusion (NEVKP) in a porcine model. Surgical techniques, set up for the perfusion solution and the circuit, potential assessment options, and representative results are demonstrated.

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation

The severe organ shortage has resulted in increased use of marginal kidney grafts for transplantation. This has triggered interest in alternative storage methods, since marginal grafts especially tolerate cold storage poorly. The technique of normothermic ex vivo kidney perfusion (NEVKP) represents a novel preservation method for kidney grafts prior to &#160;transplantation.

Normotermica<em&gt; Ex Vivo</em&gt; Rene perfusione per la Preservazione della Kidney Innesti prima del trapianto

Kidney transplantation has become a well-established treatment option for patients with end-stage renal failure. The persisting organ shortage remains a ...

An &#8220;All-laser&#8221; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

An &amp;#8220;All-laser&amp;#8221; Endothelial Transplant

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

Un &quot;All-laser&quot; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the availability of the widest range of molecular probes and reagents to perform in vivo as well as in vitro studies. Based on our experience with various murine transplantation models, we developed a heterotopic pancreas transplantation model in mice with the intent to analyze mechanisms underlying severe ischemia reperfusion injury-associated early graft damage. In contrast to previously described techniques using suture techniques, herein we describe a new procedure using a non-suture cuff technique. 
In recent years, we have performed more than 300 pancreas transplantations in mice with an overall success rate of &gt;90%, a success rate never described before in mouse pancreas transplantation. The backbone of this non-suture cuff technique for graft revascularization consists of two major steps: (I) pulling the recipient vessel over a polyethylene/polyamide cuff and fixing it with a circumferential ligature, and (II) placing the donor vessel over the everted recipient vessel and fixing it with a second circumferential ligature. The resultant continuity of the endothelial layer results in less thrombogenic lesions with high patency rates and, finally, high success rates.
In this model, arterial anastomosis is achieved by pulling the abdominal aorta of the donor graft over the everted common carotid artery of the recipient animal. Venous drainage of the graft is achieved by pulling the portal vein of the graft over the everted external jugular vein of the recipient. This manuscript provides details and crucial steps of the organ recovery and organ implantation procedures, which will allow researchers with microsurgical skills to perform the transplantation successfully in their laboratories.

Among abdominal solid organ transplantation, pancreatic grafts are prone to develop severe ischemia reperfusion injury-associated graft damage, leading eventually to early graft loss. This protocol describes a model of murine pancreas transplantation using a non-suture cuff technique, ideally suited for analyzing these early, deleterious damages.

Modello di topo per il trapianto di Pancreas usando una tecnica modificata polsino

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the ...

Murine Cervical Aortic Transplantation Model using a Modified Non-Suture Cuff Technique

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. However, only minor improvement in the long-term results of transplanted solid organs could be observed over the past decades. In this context, chronic allograft vasculopathy (CAV) still represents the leading cause of late organ failure in cardiac, renal and pulmonary transplantation.
Thus far, the underlying pathogenesis of CAV development remains unclear, explaining why effective treatment strategies are presently missing and emphasizing a need for relevant experimental models in order to study the underlying pathophysiology leading to CAV formation. The following protocol describes a murine heterotopic cervical aortic transplantation model using a modified non-suture cuff technique. In this technique, a segment of the thoracic aorta is interpositioned in the right common carotid artery. With the use of the non-suture cuff technique, an easy to learn and reproducible model can be established, minimizing the possible heterogeneity of sutured vascular micro anastomoses.

Here, we present a protocol of heterotopic aortic transplantation in mice using the non-suture cuff technique in a cervical murine model. This model can be used to study the underlying pathology of chronic allograft vasculopathy (CAV) and can help evaluate new therapeutic agents in order to prevent its formation.

Modello di trapianto aortico cervicale murine utilizzando una tecnica di manette non sutura modificata

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. ...