Surgical Tips and Tricks for Performing Porcine Pancreas Transplantation

Podsumowanie

The video article summarizes the technique of pancreatectomy and pancreas allotransplantation in a porcine 3-day survival model with a step-by-step description of the method and emphasis on the surgical tips and tricks to deal with the precarious and delicate porcine visceral anatomy.

Streszczenie

Despite the promising results of pancreas transplantation in type 1 diabetes mellitus and metabolic syndrome, the biggest concern around this state-of-the-art technique remains the paucity of organs deemed fit for transplantation. High intravascular resistance, delicate intraparenchymal capillary framework, and complex lobular anatomy around the mesenteric vasculature are what make this organ more susceptible to injury and less tolerant to trivial trauma compared to organs such as the liver and kidney. Meticulous surgical dissection and judicious tissue handling form the cornerstone of the entire exercise of pancreas transplantation. Owing to morphological similarity between the anatomy of the porcine pancreas to the surrounding mesenteric vessels and the organs when compared to the human anatomy, demonstration of the technique in the porcine model could help to most accurately extrapolate this to a human setting. The present article aims to outline the essential surgical tips and tricks that need to be followed, in order to ensure a higher success rate of transplantation of this highly susceptible organ in a porcine 3-day survival model.

Wprowadzenie

Over the past several decades, there has been significant progress in perioperative management strategies and surgical techniques leading to the evolution of pancreas transplantation into one of the most promising strategies for the treatment of diabetes mellitus with end-stage renal disease (usually in conjunction with kidney transplantation)¹. However, complications such as graft pancreatitis, ischemia-reperfusion injury, and vascular thrombosis remain the biggest challenges to overcome to ensure successful outcomes, more so in the more damaged extended criteria grafts². In addition, pancreas grafts are the most common....

Protokół

The protocol received ethical approval from the Animal Care Committee, Toronto general research institute. Animals received humane care in compliance with the National Society of Medical Research and Guide for the care of laboratory animals, National Institute of Health (NIH), Ontario, Canada. For this study, 15-week-old unrelated Yorkshire male swine, weighing 40-50 kg were used.

NOTE: The entire protocol of the study is divided into the following major steps: (i) Organ retrieval and back-table preparation; (ii) Recipient total pancreatectomy and (iii) Graft implantation. The entire surgery of donor and recipient is done in 1 day.

Wyniki

The peri-operative and post-operative, up to 3-day, biochemical parameters from the five pancreas transplant survival models are summarized below (numbered as PTX 1 to 5 in chronology). Of the five total pancreas transplants, all fared well during the 3-day survival period, as evident by their general well-being and the pancreatic injury and endocrine function tests. The results depicted below are representative of the experience of a 3-day survival model of recipient pancreatectomy followed by pancreas allotransplantati.......

Dyskusje

The current protocol has been performed to demonstrate the technique and the feasibility of pancreatectomy and pancreas allotransplantation in porcine models. The animals were observed for a period of 3 days after transplantation to demonstrate the reliability of the technique of pancreatectomy and the allotransplantation. All animals were monitored and nursed for 3 days after the surgery using a standardized animal care protocol of antibiotics, fluids, analgesics, supplemental nutrition, and immunosuppressants (i.e., cy.......

Materiały

Name	Company	Catalog Number	Comments
Belzer UW Cold storage solution	Bridge to life Ltd (Columbia, SC, USA)	4055
Calcium gluconate (10%)	Fresenius Kabi Canada Ltd (Toronto, ON)	C360019
Composelect (blood collection bags)	Fresenius Kabi Canada Ltd (Toronto, ON)	PQ31555
Heparin (10000 IU/10 ml)	Fresenius Kabi Canada Ltd (Toronto, ON)	C504710
Lactated Ringer's	Baxter (Mississauga, ON, Canada)	JB2324
Percutaneous Sheath Introducer Set with Integral Hemostasis Valve/side Port for use with 7-7.5 Fr Catheters	Arrow International LLC	SI-09880
Sodium bicarbonate (8.4%)	Fresenius Kabi Canada Ltd (Toronto, ON)	C908950
Solu-Medrol	Pfizer Canada Inc.	52246-14-2
Surgical retreival and transplant instrument set