We would like to acknowledge the useful suggestions given by Dr. Wen-tao Li and Dr. Ji-hua Wu of the Second Affiliated Hospital of Guangxi Medical University. The authors would like to thank our team-mates for useful comments and discussions. The authors would also like to thank the anonymous reviewers and editors of JoVE for their comments. Special thanks should go to Dr Yuan&#39;s parents for their continuous support and encouragement. The work was supported by Ningbo Natural Science Foundation (2014A610248).

The Animal Ethics Committee approved the experiment of Guangxi Medical University (No20190920). All animals were supplied by the Animal Experiment Center of Guangxi Medical University. We used SPF male Sprague Dawley rats (200-250 g, 10-12 weeks), kept under the room temperature of 25 &#177; 2&#176;C and humidity of 50 &#177; 10%. Feeding was stopped 24 hours before operation; however, water was provided.
NOTE: One operator can perform all operations without a microsurgery basis or surgical microscope.
1. Operation
<ol>
	<li>After weighing, anesthetize the rats with isoflurane (5%) using an animal anesthesia machine.</li>
	<li>After 1-2 minutes, gently clamp the toes of the rat with tweezers. If the rat does not respond after pinching, it has entered a state of anesthesia. Use vet ointment on the eyes to prevent dryness. Use animal heating lamps to keep the rats&#39; body temperature at 37-38 &#176;C.</li>
	<li>Following abdominal disinfection (povidone iodine solution), fix the rat on the animal dissection table. Make a median incision of 3 cm below the xiphoid process using forceps and scissors.</li>
	<li>Open the abdominal cavity, expose the liver using a retractor, and mobilize the hepatogastric ligament. Use cotton swabs to flip the middle lobe of the liver gently and turn it upward to expose the porta hepatis. Identify the CBD, PV, and HA.</li>
	<li>Push the small intestine toward the left lower abdominal cavity using cotton swabs, cover it with wet gauze, and move the intrahepatic vena cava to the right renal vein.</li>
	<li>Isolate the portal vein, hepatic artery, and the inferior vena cava above the right renal vein with an intraocular lens and forceps marked with 3-0 silk thread, each with a slip knot.</li>
	<li>Cut open the left and right lower extremity skin and expose the femoral vein using ophthalmic forceps. Slowly inject low molecular weight heparin 625 IU/kg through the femoral vein to heparinize the whole body.</li>
	<li>Ligate the portal vein, hepatic artery, and inferior vena cava above the right renal vein with No. 3-0 sutures, lasting 45 minutes (Figure 1). Replace the small intestine in the abdominal cavity and cover it with gauze. Reduce inhalation anesthesia during these periods.</li>
	<li>After 45 minutes, release the portal vein, hepatic artery, and the inferior vena cava above the right renal vein.</li>
	<li>Suture the muscle and skin, layer by layer, and terminate the inhalational anesthesia. Provide postoperative analgesia using subcutaneous morphine of 5 mg/kg every 4 hours.</li>
	<li>Observe the rat until it is awake and feed under a temperature of 25 &#177; 2 &#176;C and humidity of 50 &#177; 10%. Animal heating lamps are necessary.</li>
</ol>

<ol>
	<li>Dar, W. A., Sullivan, E., Byon, J. S., Eltzschig, H., Ju, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ischaemia+reperfusion+injury+in+liver+transplantation:+Cellular+and+molecular+mechanisms.">Ischaemia reperfusion injury in liver transplantation: Cellular and molecular mechanisms.</a> Liver International. 39 (5), 788-801 (2019).</li><li>Qiao, P. F., Yao, L., Zhang, X. C., Li, G. D., Wu, D. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heat+shock+pretreatment+improves+stem+cell+repair+following+ischemia-reperfusion+injury+via+autophagy.">Heat shock pretreatment improves stem cell repair following ischemia-reperfusion injury via autophagy.</a> World Journal of Gastroenterology. 21 (45), 12822-12834 (2015).</li><li>Liu, Y., 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=Activation+of+YAP+attenuates+hepatic+damage+and+fibrosis+in+liver+ischemia-reperfusion+injury.">Activation of YAP attenuates hepatic damage and fibrosis in liver ischemia-reperfusion injury.</a> Journal of Hepatology. 71 (4), 719-730 (2019).</li><li>Hirao, H., Dery, K. J., Kageyama, S., Nakamura, K., Kupiec-Weglinski, 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=Heme+Oxygenase-1+in+liver+transplant+ischemia-reperfusion+injury:+From+bench-to-bedside.">Heme Oxygenase-1 in liver transplant ischemia-reperfusion injury: From bench-to-bedside.</a> Free Radical Biology and Medicine. 157, 75-82 (2020).</li><li>Moti&#241;o, O., 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=Protective+role+of+hepatocyte+cyclooxygenase-2+expression+against+liver+ischemia-reperfusion+injury+in+mice.">Protective role of hepatocyte cyclooxygenase-2 expression against liver ischemia-reperfusion injury in mice.</a> Hepatology. 70 (2), 650-665 (2019).</li><li>Guo, W. 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H., Ko, J. S., Gwak, M. S., Lee, S. K., Kim, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+clinical+significance+of+hyperfibrinolysis+during+living+donor+liver+transplantation.">Incidence and clinical significance of hyperfibrinolysis during living donor liver transplantation.</a> Blood Coagulation and Fibrinolysis. 29 (3), 322-326 (2018).</li><li>Czig&#225;ny, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+research+practice+in+rat+orthotopic+and+partial+orthotopic+liver+transplantation:+a+review,+recommendation,+and+publication+guide.">Improving research practice in rat orthotopic and partial orthotopic liver transplantation: a review, recommendation, and publication guide.</a> European Surgical Research. 55 (1-2), 119-138 (2015).</li><li>Kamada, N., Calne, R. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Orthotopic+liver+transplantation+in+the+rat.+Technique+using+cuff+for+portal+vein+anastomosis+and+biliary+drainage.">Orthotopic liver transplantation in the rat. Technique using cuff for portal vein anastomosis and biliary drainage.</a> Transplantation. 28 (1), 47-50 (1979).</li><li>Zimmermann, F. 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=Techniques+for+orthotopic+liver+transplantation+in+the+rat+and+some+studies+of+the+immunologic+responses+to+fully+allogeneic+liver+grafts.">Techniques for orthotopic liver transplantation in the rat and some studies of the immunologic responses to fully allogeneic liver grafts.</a> Transplantation Proceedings. 11 (1), 571-577 (1979).</li><li>Miyata, M., Fischer, J. H., Fuhs, M., Isselhard, W., Kasai, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+simple+method+for+orthotopic+liver+transplantation+in+the+rat.+Cuff+technique+for+three+vascular+anastomoses.">A simple method for orthotopic liver transplantation in the rat. Cuff technique for three vascular anastomoses.</a> Transplantation. 30 (5), 335-338 (1980).</li><li>Kamada, N. A., Calne, R. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+experience+with+five+hundred+thirty+liver+transplants+in+the+rat.">Surgical experience with five hundred thirty liver transplants in the rat.</a> Surgery. 93 (1), 64-69 (1983).</li><li>Yang, L. 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A morphological, hemodynamic, and metabolic reappraisal.</a> Archives of Surgery. 101 (4), 478-483 (1970).</li><li>Kozian, 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=One-lung+ventilation+induces+hyperfusion+and+alveolar+damage+in+the+ventilated+lung:an+experimental+study.">One-lung ventilation induces hyperfusion and alveolar damage in the ventilated lung:an experimental study.</a> British Journal of Anaesthesia. 100 (4), 549-559 (2008).</li><li>Shimada, S., 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=Heavy+water+(D2O)+containing+preservation+solution+reduces+hepatic+cold+preservation+and+reperfusion+injury+in+an+isolated+perfused+rat+liver+(IPRL)+model.">Heavy water (D2O) containing preservation solution reduces hepatic cold preservation and reperfusion injury in an isolated perfused rat liver (IPRL) model.</a> Journal of Clinical Medicine. 8 (11), 1818 (2019).</li><li>Nakamura, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sirtuin+1+attenuates+inflammation+and+hepatocellular+damage+in+liver+transplant+ischemia/reperfusion:+from+mouse+to+human.">Sirtuin 1 attenuates inflammation and hepatocellular damage in liver transplant ischemia/reperfusion: from mouse to human.</a> Liver Transplantation. 23 (10), 1282-1293 (2017).</li><li>Blaire, 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=Surgical+Considerations+of+Hilar+Cholangiocarcinoma.">Surgical Considerations of Hilar Cholangiocarcinoma.</a> Surgical Oncology Clinics of North America. 28 (4), 601-617 (2019).</li></ol>

The authors of this manuscript have no conflicts of interest to disclose.

OLT in rats is an ideal model for studying organ preservation in liver transplantation, IRI, transplant rejection, immune tolerance, transplantation pathology and pharmacology, homotransplantation, and xenotransplantation. At present, it is widely used in the experimental research of liver transplantation.
During pilot studies we first administered pentobarbital sodium intraperitoneal anesthesia and found that this led to high postoperative mortality and short tolerance to hemodynamic changes....

Ischemia-reperfusion injury (IRI) is a common complication after liver transplantation. Hepatic IRI is a pathological process involving ischemia-mediated cell damage and abnormal deterioration of liver reperfusion. Hepatic IRI and the local innate immune response can be divided into hot and cold IRI, according to differences in the clinical environment1. Hot IRI is induced by stem cell injury, usually as a result of liver transplantation, shock, and trauma2. Cold IRI is a complication of liver transplantation caused by endothelial cells and peripheral circulation3. Clinical reports have shown that hepatic IRI is associated with 10% of early organ failures and may increase the incidence of acute and chronic rejection4,5. In addition, hepatic IRI may also induce multiple organ dysfunction syndromes or systemic inflammatory response syndrome, with high mortality6. Patients with extrahepatic organ involvement tend to stay longer in the hospital, spend more money, and have a worse prognosis7. The development of complications is closely related to the length of the anhepatic phase of liver transplantation8.
Orthotopic liver transplantation (OLT) in rats was first reported by the American professor Lee in 1973. The experimental operation simulated the steps of clinical liver transplantation and the anastomosis of blood vessels and the common bile duct (CBD) using the suture method. The procedure is difficult and time-consuming with a low rate of success9. In 1979, Kamada et al. made a significant improvement to OLT in rats by creatively using the &#39;two-cuff method&#39; for anastomosis of the portal vein to control the anhepatic phase within 26 minutes10. In the same year, Zimmermann proposed the &#39;single biliary stent method.&#39; On the basis of Lee&#39;s work, Zimmermann used polyethylene tubes to directly anastomose the CBD of the donor and recipient, simplified the reconstruction of CBD, and preserved the function of the sphincter, and this method became the standard for biliary reconstruction of OLT models11. In 1980, Miyata et al. proposed the &#39;three-cuff method&#39; where the portal vein (PV), suprahepatic vena cava (SVC), and intrahepatic vena cava (IVC) were anastomosed by the cuff method. However, there is a risk of distortion of the cannula with this method, which can lead to the obstruction of inferior vena cava reflux12. In 1983, the &#39;two-cuff method&#39; was proposed using the cuff method for anastomosis of the PV and IVC, but adopting the suture method for the SVC13. This method was adopted by scholars globally to establish OLT models. Since then, the cuff anastomosis steps have been improved to shorten the anhepatic phase and improve the survival rate of the rats14. Similarly, improved methods are used in clinical practice to shorten the anhepatic phase15. However, basic research into IRI after liver transplantation has shown that the survival rate is inversely related to the degree of injury to extrahepatic organs. Therefore, further research is required, and a simple and reproducible animal model is needed to simulate IRI after liver transplantation.
Based on the definition of the anhepatic phase, we simulated the hemodynamic changes in liver transplantation resulting in IRI of extrahepatic organs in rats. Herein, we provide a detailed description of how to build an animal model of the anhepatic phase (liver ischemia) in rats to facilitate basic research into IRI after liver transplantation.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>4% paraformaldehyde solution</td>
			<td>Shanghai Macklin Biochemical Co.,Ltd</td>
			<td>P804536</td>
			<td></td>
		</tr>
		<tr>
			<td>air drying oven</td>
			<td>Shanghai Binglin Electronic Technology Co., Ltd.</td>
			<td>BPG</td>
			<td></td>
		</tr>
		<tr>
			<td>Alanine aminotransferase (ALT)Kit</td>
			<td>Elabscience Biotechnology Co.,Ltd</td>
			<td>E-BC-K235-S</td>
			<td></td>
		</tr>
		<tr>
			<td>ammonia</td>
			<td>Sinopharm Chemical Reagents Co. Ltd</td>
			<td>10002118</td>
			<td></td>
		</tr>
		<tr>
			<td>amylase Kit</td>
			<td>Elabscience Biotechnology Co.,Ltd</td>
			<td>E-BC-K005-M</td>
			<td></td>
		</tr>
		<tr>
			<td>anhydrous ethanol</td>
			<td>Sinopharm Chemical Reagents Co. Ltd</td>
			<td>100092183</td>
			<td></td>
		</tr>
		<tr>
			<td>Animal anesthesia machine</td>
			<td>Shenzhen Ruiwode Life Technology Co. Ltd</td>
			<td>R640</td>
			<td></td>
		</tr>
		<tr>
			<td>aspartate aminotransferase (AST)kit</td>
			<td>Rayto Life and Analytical Sciences Co., Ltd.</td>
			<td>S03040</td>
			<td></td>
		</tr>
		<tr>
			<td>automatic biochemical analyzer.</td>
			<td>SIEMENS AG FWB:SIE, NYSE:SI Co., Ltd.</td>
			<td>2400</td>
			<td></td>
		</tr>
		<tr>
			<td>Biosystems (when nessary)</td>
			<td>Chengdu Taimeng Electronics Co., Ltd.</td>
			<td>BL-420F</td>
			<td></td>
		</tr>
		<tr>
			<td>Centrifuge</td>
			<td>Baiyang Medical Instrument Co., Ltd.</td>
			<td>BY-600A</td>
			<td></td>
		</tr>
		<tr>
			<td>cover glass</td>
			<td>Jiangsu Shitai Experimental Equipment Co. Ltd</td>
			<td>10212432C</td>
			<td></td>
		</tr>
		<tr>
			<td>creatinine Kit</td>
			<td>Rayto Life and Analytical Sciences Co., Ltd.</td>
			<td>S03076</td>
			<td></td>
		</tr>
		<tr>
			<td>dewatering machine</td>
			<td>Hungary 3DHISTECH Co.,Ltd</td>
			<td>Donatello Series 2</td>
			<td></td>
		</tr>
		<tr>
			<td>embedding machine</td>
			<td>Hubei Xiaogan Kuohai Medical Technology Co., Ltd.</td>
			<td>KH-BL1</td>
			<td></td>
		</tr>
		<tr>
			<td>frozen machine</td>
			<td>Wuhan Junjie Electronics Co., Ltd</td>
			<td>JB-L5</td>
			<td></td>
		</tr>
		<tr>
			<td>hematoxylin-eosin dye solution</td>
			<td>Wuhan Saiwell Biotechnology Co., Ltd</td>
			<td>G1005</td>
			<td></td>
		</tr>
		<tr>
			<td>high-efficiency paraffin wax</td>
			<td>Shanghai huayong paraffin wax co., Ltd</td>
			<td>Q/YSQN40-91</td>
			<td></td>
		</tr>
		<tr>
			<td>hydrochloric acid</td>
			<td>Sinopharm Chemical Reagents Co. Ltd</td>
			<td>10011018</td>
			<td></td>
		</tr>
		<tr>
			<td>intraocular lens (IOL)forceps</td>
			<td>Guangzhou Guangmei Medical Equipment Co., Ltd.</td>
			<td>JTZRN</td>
			<td></td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Shenzhen Ruiwode Life Technology Co. Ltd</td>
			<td>&#8212;</td>
			<td></td>
		</tr>
		<tr>
			<td>micro Scissors(when nessary)</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>WA1010</td>
			<td></td>
		</tr>
		<tr>
			<td>needle holders</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>J32010</td>
			<td></td>
		</tr>
		<tr>
			<td>neutral gum</td>
			<td>Shanghai Huashen Healing Equipment Co.,Ltd.</td>
			<td>&#8212;</td>
			<td></td>
		</tr>
		<tr>
			<td>normal optical microscope</td>
			<td>Nikon Instrument Shanghai Co., Ltd</td>
			<td>Nikon Eclipse CI</td>
			<td></td>
		</tr>
		<tr>
			<td>ophthalmic forceps</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>J3CO30</td>
			<td>straight</td>
		</tr>
		<tr>
			<td>ophthalmic forceps</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>JD1060</td>
			<td>bending</td>
		</tr>
		<tr>
			<td>ophthalmic Scissors</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>J1E0</td>
			<td></td>
		</tr>
		<tr>
			<td>pathological slicer</td>
			<td>Shanghai Leica Instrument Co., Ltd</td>
			<td>RM2016</td>
			<td></td>
		</tr>
		<tr>
			<td>pipettes</td>
			<td>Dragon Laboratory Instruments Co., Ltd.</td>
			<td>7010101008</td>
			<td></td>
		</tr>
		<tr>
			<td>retractors</td>
			<td>Beijing Jinuotai Technology Development Co.,Ltd.</td>
			<td>JNT-KXQ</td>
			<td></td>
		</tr>
		<tr>
			<td>scanner</td>
			<td>Hungary 3DHISTECH Co.,Ltd</td>
			<td>Pannoramic 250</td>
			<td></td>
		</tr>
		<tr>
			<td>slide</td>
			<td>Wuhan Saiwell Biotechnology Co., Ltd</td>
			<td>G6004</td>
			<td></td>
		</tr>
		<tr>
			<td>xylene</td>
			<td>Sinopharm Chemical Reagents Co. Ltd</td>
			<td>1330-20-7</td>
			<td></td>
		</tr>
	</tbody>
</table>

organ ischemia-reperfusion injury by simulating hemodynamic changes in rat liver transplant model

Orthotopic liver transplantation (OLT) in rats is a tried and proven animal model used for preoperative, intraoperative, and postoperative studies, including ischemia-reperfusion injury (IRI) of extrahepatic organs. This model requires numerous experiments and devices. The duration of anhepatic phase is closely related to the time to develop IRI after transplantation. In this experiment, we used hemodynamic changes to induce extrahepatic organ damage in rats and determined the maximum tolerance time. The time until the most severe organ injury varied for different organs. This method can easily be replicated and can also be used to study IRI of the extrahepatic organs after liver transplantation.

Rats&#39; tolerance to liver ischemia 
In this animal model, the sites at which blood vessels were ligated during operating are shown in Figure 1. The rats were randomly divided into 5 groups for ischemia for 15 minutes (I15 group), 30 minutes (I30 group), 45 minutes (I45 group), 60 minutes (I60), and sham group, with 10 rats in each group. The survival rate of each group was observed 14 days after the operation. All rats survived in the I15 group, I30 group, and sham g...

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Organ Ischemia-Reperfusion Injury by Simulating Hemodynamic Changes in Rat Liver Transplant Model

This paper provides a detailed description of how to build an animal model of the anhepatic phase (liver ischemia) in rats to facilitate basic research into ischemia-reperfusion injury after liver transplantation.

Orthotopic liver transplantation (OLT) in rats is a tried and proven animal model used for preoperative, intraoperative, and postoperative studies, ...

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4.9K Views.  The Second Affiliated Hospital of Guangxi Medical University. This paper provides a detailed description of how to build an animal model of the anhepatic phase (liver ischemia) in rats to facilitate basic research into ischemia-reperfusion injury after liver transplantation.

Video: Organ Ischemia-Reperfusion Injury by Simulating Hemodynamic Changes in Rat Liver Transplant Model

Normothermic Cardiac Arrest and Cardiopulmonary Resuscitation: A Mouse Model of Ischemia-Reperfusion Injury

Acute Kidney Injury (AKI) is a common, highly lethal, complication of critical illness which has a high mortality1-4 and which is most 
frequently caused by whole-body hypoperfusion.5,6 Successful reproduction of whole-body hypoperfusion in rodent models has been fraught with 
difficulty.7-9,9,10 Models which employ focal ischemia have repeatedly demonstrated results which do not translate to the clinical setting, and larger 
animal models which allow for whole body hypoperfusion lack access to the full toolset of genetic manipulation possible in the mouse.11,12 However, in recent 
years a mouse model of cardiac arrest and cardiopulmonary resuscitation has emerged which can be adapted to model AKI.13 This model reliably reproduces 
physiologic, functional, anatomic, and histologic outcomes seen in clinical AKI, is rapidly repeatable, and offers all of the significant advantages of a murine surgical 
model, including access to genetic manipulative techniques, low cost relative to large animals, and ease of use. Our group has developed extensive experience 
with use of this model to assess a number of organ-specific outcomes in AKI.14,15

A powerful model for perioperative and critical care related acute kidney injury is presented. Using whole body hypoperfusion induced by cardiac arrest it is possible to nearly replicate the histologic and functional changes of clinical AKI.

Acute Kidney Injury (AKI) is a common, highly lethal, complication of critical illness which has a high mortality1-4 and which is most 
frequently caused ...

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury.

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

Free tissue transfer is widely employed in reconstructive surgery to restore form and function following oncological resection and trauma. Preconditioning this tissue prior to surgery may improve outcome. This article describes an in situ transverse rectus abdominis myocutaneous flap (TRAM) in rats as a means for testing preconditioning strategies.

Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite ...

Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice

Ischemia-reperfusion induced acute kidney injury (IR-AKI) is widely used as a model of AKI in mice, but results are often quite variable with high, often unreported mortality rates that may confound analyses. Bilateral renal pedicle clamping is commonly used to induce IR-AKI, but differences between effective clamp pressures and/or renal responses to ischemia between kidneys often lead to more variable results. In addition, shorter clamp times are known to induce more variable tubular injury, and while mice undergoing bilateral injury with longer clamp times develop more consistent tubular injury, they often die within the first 3 days after injury due to severe renal insufficiency. To improve post-injury survival and obtain more consistent and predictable results, we have developed two models of unilateral ischemia-reperfusion injury followed by contralateral nephrectomy. Both surgeries are performed using a dorsal approach, reducing surgical stress resulting from ventral laparotomy, commonly used for mouse IR-AKI surgeries. For induction of moderate injury BALB/c mice undergo unilateral clamping of the renal pedicle for 26 min and also undergo simultaneous contralateral nephrectomy. Using this approach, 50-60% of mice develop moderate AKI 24 hr after injury but 90-100% of mice survive. To induce more severe AKI, BALB/c mice undergo renal pedicle clamping for 30 min followed by contralateral nephrectomy 8 days after injury. This allows functional assessment of renal recovery after injury with 90-100% survival. Early post-injury tubular damage as well as post injury fibrosis are highly consistent using this model.

We describe models of moderate and severe ischemia-reperfusion-induced kidney injury in which the mice undergo unilateral renal pedicle clamping followed by simultaneous or delayed contralateral nephrectomy, respectively. These models consistently give rise to renal dysfunction and post-injury fibrosis, but injury severity and survival are dependent on mouse background, age and surgical equipment.

Ischemia-reperfusion induced acute kidney injury (IR-AKI) is widely used as a model of AKI in mice, but results are often quite variable with high, often ...

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.

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

Induction and Assessment of Ischemia-reperfusion Injury in Langendorff-perfused Rat Hearts

The biochemical events surrounding ischemia reperfusion injury in the acute setting are of great importance to furthering novel treatment options for myocardial infarction and cardiac complications of thoracic surgery. The ability of certain drugs to precondition the myocardium against ischemia reperfusion injury has led to multiple clinical trials, with little success. The isolated heart model allows acute observation of the functional effects of ischemia reperfusion injury in real time, including the effects of various pharmacological interventions administered at any time-point before or within the ischemia-reperfusion injury window. Since brief periods of ischemia can precondition the heart against ischemic injury, in situ aortic cannulation is performed to allow for functional assessment of non-preconditioned myocardium. A saline filled balloon is placed into the left ventricle to allow for real-time measurement of pressure generation. Ischemic injury is simulated by the cessation of perfusion buffer flow, followed by reperfusion. The duration of both ischemia and reperfusion can be modulated to examine biochemical events at any given time-point. Although the Langendorff isolated heart model does not allow for the consideration of systemic events affecting ischemia and reperfusion, it is an excellent model for the examination of acute functional and biochemical events within the window of ischemia reperfusion injury as well as the effect of pharmacological intervention on cardiac pre- and postconditioning. The goal of this protocol is to demonstrate how to perform in situ aortic cannulation and heart excision followed by ischemia/reperfusion injury in the Langendorff model.

The isolated rat heart is an enduring model for ischemia reperfusion injury. Here, we describe the process of harvesting the beating heart from a rat via in situ aortic cannulation, Langendorff perfusion of the heart, simulated ischemia-reperfusion injury, and infarct staining to confirm the extent of ischemic insult.

The biochemical events surrounding ischemia reperfusion injury in the acute setting are of great importance to furthering novel treatment options for ...

Murine Model of Intestinal Ischemia-reperfusion Injury

Intestinal ischemia is a life-threatening condition associated with a broad range of clinical conditions including atherosclerosis, thrombosis, hypotension, necrotizing enterocolitis, bowel transplantation, trauma and chronic inflammation. Intestinal ischemia-reperfusion (IR) injury is a consequence of acute mesenteric ischemia, caused by inadequate blood flow through the mesenteric vessels, resulting in intestinal damage. Reperfusion following ischemia can further exacerbate damage of the intestine. The mechanisms of IR injury are complex and poorly understood. Therefore, experimental small animal models are critical for understanding the pathophysiology of IR injury and the development of novel therapies.
Here we describe a mouse model of acute intestinal IR injury that provides reproducible injury of the small intestine without mortality. This is achieved by inducing ischemia in the region of the distal ileum by temporally occluding the peripheral and terminal collateral branches of the superior mesenteric artery for 60 min using microvascular clips. Reperfusion for 1 hr, or 2 hr after injury results in reproducible injury of the intestine examined by histological analysis. Proper position of the microvascular clips is critical for the procedure. Therefore the video clip provides a detailed visual step-by-step description of this technique. This model of intestinal IR injury can be utilized to study the cellular and molecular mechanisms of injury and regeneration.

Here we describe the detailed procedure of intestinal ischemia-reperfusion in mice which results in reproducible injury without mortality to encourage the standardization of this technique across the field. This model of intestinal ischemia-reperfusion injury can be utilized to study the cellular and molecular mechanisms of injury and regeneration.

Intestinal ischemia is a life-threatening condition associated with a broad range of clinical conditions including atherosclerosis, thrombosis, ...

Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ischemia/reperfusion (I/R) injury with myriad negative consequences. Potential I/R injury in marginal organs destined for liver transplantation contributes to the current donor shortage secondary to a decreased organ utilization rate. A significant need exists to explore hepatic I/R injury in order to mediate its impact on graft function in transplantation. Rat liver hilar clamp models are used to investigate the impact of different molecules on hepatic I/R injury. Depending on the model, these molecules have been delivered using inhalation, epidural infusion, intraperitoneal injection, intravenous administration or injection into the peripheral superior mesenteric vein. A rat liver hilar clamp model has been developed for use in studying the impact of pharmacologic molecules in ameliorating I/R injury. The described model for rat liver hilar clamp includes direct cannulation of the portal supply to the ischemic hepatic segment via a side branch of the portal vein, allowing for direct segmental hepatic delivery. Our approach is to induce ischemia in the left lateral and median lobes for 60 min, during which time the substance under study is infused. In this case, pegylated-superoxide dismutase (PEG-SOD), a free radical scavenger, is infused directly into the ischemic segment. This series of experiments demonstrates that infusion of PEG-SOD is protective against hepatic I/R injury. Advantages of this approach include direct injection of the molecule into the ischemic segment with consequent decrease in volume of distribution and reduction in systemic side effects.

A unique rat liver hilar clamp model was developed for studying the impact of pharmacologic molecules in ameliorating ischemia-reperfusion injury. This model includes direct cannulation of the portal supply to the ischemic liver segment via a branch of the portal vein, allowing for direct hepatic delivery.

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ...

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

There is a significant shortage of liver allografts available for transplantation, and in response the donor criteria have been expanded. As a result, normothermic ex vivo liver perfusion (NEVLP) has been introduced as a method to evaluate and modify organ function. NEVLP has many advantages in comparison to hypothermic and subnormothermic perfusion including reduced preservation injury, restoration of normal organ function under physiologic conditions, assessment of organ performance, and as a platform for organ repair, remodeling, and modification. Both murine and porcine NEVLP models have been described. We demonstrate a rat model of NEVLP and use this model to show one of its important applications &#8212; the use of a therapeutic molecule added to liver perfusate. Catalase is an endogenous reactive oxygen species (ROS) scavenger and has been demonstrated to decrease ischemia-reperfusion in the eye, brain, and lung. Pegylation has been shown to target catalase to the endothelium. Here, we added pegylated-catalase (PEG-CAT) to the base perfusate and demonstrated its ability to mitigate liver preservation injury. An advantage of our rodent NEVLP model is that it is inexpensive in comparison to larger animal models. A limitation of this study is that it does not currently include post-perfusion liver transplantation. Therefore, prediction of the function of the organ post-transplantation cannot be made with certainty. However, the rat liver transplant model is well established and certainly could be used in conjunction with this model. In conclusion, we have demonstrated an inexpensive, simple, easily replicable NEVLP model using rats. Applications of this model can include testing novel perfusates and perfusate additives, testing software designed for organ evaluation, and experiments designed to repair organs.

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

There is a significant liver donor shortage, and criteria for liver donors have been expanded. Normothermic ex vivo liver perfusion (NEVLP) has been developed to evaluate and modify organ function. This study demonstrates a rat model of NEVLP and tests the ability of pegylated-catalase, to mitigate liver preservation injury.

There is a significant shortage of liver allografts available for transplantation, and in response the donor criteria have been expanded. As a result, ...

Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats

Coronary artery disease is the leading cause of death worldwide. After an acute myocardial infarction, early and successful myocardial intervention via recanalization of the coronary artery is the most effective strategy for reducing the size of ischemic myocardium. The coronary microvasculature cannot be visualized and imaged&#160;in vivo, but there are several invasive and noninvasive techniques that can be used to assess parameters which depend directly on coronary microvascular function. The endothelial function after ischemia reperfusion can be assessed also at the level of the coronary circulation via the coronary flow reserve (CFR).&#160;In this study, peak velocity of left anterior descending (LAD) coronary arteries was measured in rats in vivo via Transthoracic Doppler Echocardiography during resting and stress challenge (induced by Dobutamine). A normal heart can increase its coronary blood flow up to four times above the resting values during stress induction. Following ischemia reperfusion, we found a significantly diminished CFR, which can be used as a marker of coronary microvascular dysfunction. CFR has opened a window on the importance of microvascular dysfunction and has been shown to predict cardiovascular risk independent of whether the severe obstructive disease is present.

Coronary flow reserve (CFR), is defined as the ratio of maximal coronary blood flow to the resting coronary blood flow. We present a protocol for evaluating CFR in rats via ultrasound, which offers the opportunity to predict cardiovascular risk factors in the absence of obstructive coronary disease.

Coronary artery disease is the leading cause of death worldwide. After an acute myocardial infarction, early and successful myocardial intervention via ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many areas of biomedical research due to its cost-effectiveness and its translation to humans. This protocol describes a method to create a preclinical free skin flap model in rats with ischemia-reperfusion injury. The described 3 cm x 6 cm rat free skin flap model is easily obtained after the placement of several vascular ligatures and the section of the vascular pedicle. Then, 8 h after the ischemic insult and completion of the microsurgical anastomosis, the free skin flap develops the tissue damage. These ischemia-reperfusion injury-related damages can be studied in this model, making it a suitable model for evaluating therapeutic agents to address this pathophysiological process. Furthermore, two main monitoring techniques are described in the protocol for the assessment of this animal model: transit-time ultrasound technology and laser speckle contrast analysis.

Here, we describe a pre-clinical animal model for studying the pathophysiology of ischemia-reperfusion injury in reconstructive microsurgery. This free skin flap model based on the superficial caudal epigastric vessels in the rat may also allow for the evaluation of different therapies and compounds to counteract ischemia-reperfusion injury-related damage.

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...