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 mi...

<ol>
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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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R., Ferris, T. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oxygen+free+radicals+in+ischemic+acute+renal+failure+In+the+rat.">Oxygen free radicals in ischemic acute renal failure In the rat.</a> Journal of Clinical Investigation. 74 (4), 1156-1164 (1984).</li><li>Schmidt, J., Lewandrowsi, K., Warshaw, A. L., Compton, C. C., Rattner, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphometric+characteristics+and+homogeneity+of+a+new+model+of+acute+pancreatitis+in+the+rat.">Morphometric characteristics and homogeneity of a new model of acute pancreatitis in the rat.</a> International Journal of Pancreatology. 12 (1), 41-51 (1992).</li><li>Chui, C. J., McArdle, A. H., Brown, R., Scott, H. J., Gurd, F. 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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...

Watch this Scientific Journal Video about Organ Ischemia-Reperfusion Injury by Simulating Hemodynamic Changes in Rat Liver Transplant Model at JoVE.com

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, ...

Organ ischemia-reperfusion injury by simulating hemodynamic changes in rat liver transplant model. Ischemia-reperfusion injury is a common application after liver transplantation. Patients with extrahepatic organ involvement tend to stay longer in hospital, spend more and haves a worse prognosis.The development of the complication is closely related to the length of the anhepatic phase of liver transplantation. However, basic research into the ischemia-reperfusion injury after liver transplantation has shown that the survival rate after liver transplantation is inversely related to the degree of injury to extrahaptic organs. Based on the definition of the anhaptic phase, we simulated the hemodynamic change in liver transplantation resulting in ischemia-reperfusion injury of extrahaptic organs.Of this paper is to provide a detailed description of how to build an animal model of the anhaptic phase in rats, basic research into the ischemia-reperfusion injury after liver transplantation. Dr.Yuan Yuan is responsible for all video animal operations. Two ophthalmic forceps, straight and bending, and interocular lens, IOL forceps, ophthalmic scissors, one to two retractors, cotton swabs, 3-0 surgical sutures, iodoform gauze, suture needles, Biosystems when necessary, and interocular lens, IOL forceps is used to separate blood vessels because of roundheads.Animal anesthesia machine, de-watering machine, embedding machine, pathological slicer, frozen machine, tissue slicer, air drying oven, neural optical microscope, the scanner, enflurane for general anesthesia, 4%paraformaldehyde solution, anyhydrous ethanol, xylene, high efficiency paraffin wax, hematoxylin-eosin dye solution, hydrochloric acid, ammonia, slide, cover glass, neutral gum and dying reagents, and consumable materials. Pipettes, centrifuge, automatic biochemical analyzer, alanine amino transferase, ALT kit, aspartate, amino transferase, AST kit, creatinine kit. After weighing, the rats are anesthetized with isoflurane by an animal anesthesia machine.Following abdominal disinfection, make a median incision of three centimeters below the xiphoid process using forceps and scissors. 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 habitis.Identify the bile duct, portal vein, and the hepatic artery. Push the small intestine towards the left lower abdominal cavity using cotton swaps and move the inferior vena cava to the right renal vein, isolate the portal vein, hepatic artery and the inferior vena cava above the right renal vein with an intraocular lens, IOL, forceps marked with 3-0 silk thread each with a slip knot. Cut open the skin of the left and right lower extremity 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. Ligate the portal vein, hepatic artery, and inferior vena cava above the right renal vein with number 3-0 sutures, lasting for 45 minutes. Replace the small intestine in the abdominal cavity and cover it with gauze.Inhalation anesthesia is reduced during these periods. After 45 minutes, release the portal vein, hepatic artery, and the inferior vena cava above the right renal vein. Suture the muscle and skin layer by layer and terminate the inhalational anesthesia.Provide post-operative analgesia using subcutaneous morphine of 5 mg/kg every four hours Observe the rat until awake and keep fed under a temperature of 25 plus or minus two degrees Celsius and humidity of 50 plus or minus 10%Animal heating lamps is necessary. In this animal model, the rats were randomly divided into five groups according to ischemia for 15 minutes, I 15 group, 30 minutes, I 30 group, 45 minutes, I 45 group, 60 minutes, I 60, and a sham group with 10 rats in each group. Their survival rate of each group was observed 14 days after the operation.All rats survived in the I 15, I 30 and sham groups. Eight survived for 14 days in the I 45 group and only two survived in the I 60 group. The results suggested that the rats could tolerate the anhepatic phase for 45 minutes at most.During the experiment, Biosystems was used to record the changes of heart rate and blood pressure, right internal carotid artery intubation before and after the anhepatic phase. We found that the heart rate and mean arterial pressure, MAP of rats, changed dramatically after vascular ligation. After ligation, hepatic ischemia, congestion, and edema in the intestines, gastric varices and splenomegaly were evident.80 rats were randomly divided into eight groups including ischemia for 45 minutes, T0, reperfusion for six hours, T6, 12 hours, T12, 24 hours, T24, 48 hours, T48, 72 hours, T72, seven days, T7, in 14 days, T14, respectively. The kidney, pancreas, small intestine, heart and lung tissues were taken and stained with HE after rats were sacrificed. Except for the heart, pathological scores were given according to references, respectively.The results showed that the time of maximum injury of the extrahepatic organs varied. It was six to 24 hours after operation for the pancreas and 24 to 48 hours for the lungs. The intestinal tract and kidney were most severely injured after 45 minutes of ischemia.There was no obvious abnormality of the intestinal mucosa 24 hours after the operation and the kidneys recovered after 48 hours. As for the heart, with the passage of time after reperfusion, local myocardial cell narcosis, cell fragmentation and dissolution, inflammatory cell infiltration, and local vasodilation and congestion were found in the tissue by 24 to 48 hours after the operation. Serum was collected and the levels of ALT, AST, creatinine, and amylase were detected by an automatic biochemical analyzer.All indicators peaked at 24 to 48 hours, unlike the pathological changes. Although the levels were basically normal 48 hours after the operation, the pathological damage was still continuing. For summarize, the model in rats is simple and easier to use without microsurgery and provides basis to fundamental research of the ischemia-reperfusion injury of extrahepatic organs after hepatic ischemia.

organ-ischemia-reperfusion-injury-simulating-hemodynamic-changes-rat

Research

JoVE Journal

Medicine

4.9K Görüntüleme.  The Second Affiliated Hospital of Guangxi Medical University. Sıçan karaciğer nakli modelinde hemodinamik değişiklikler simüle ederek organ iskemi-reperfüzyon yaralanması. İskemi-reperfüzyon hasarı karaciğer naklinden sonra sık görülen bir uygulamadır. Ekstrahepatik organ tutulumu olan hastalar hastanede daha uzun süre kalma eğilimindedir, daha fazla harcama eğilimindedir ve daha kötü bir prognoza sahiptir.Komplikasyonun gelişimi karaciğer naklinin anhepatik fazının uzunluğu ile yakından ilgilidir. Bununla birlikte, kar...