Name: porcine liver transplantation without veno-venous bypass as an extended criteria donor model
Uploaded: 2022-08-17T14:00:00
Description: Watch this Scientific Journal Video about Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model at JoVE.com

作者感谢Britta Trautewig，Corinna Löbbert，Astrid Dinkel和Ingrid Meder的勤奋和承诺。此外，作者感谢Tom Figiel制作图片材料。

这项研究是在下萨克森州消费者保护和食品安全管理局（Niedersächsisches Landesamt für Verbraucherschutz und Lebensmittelsicherheit [LAVES]; 19/3146）批准后在汉诺威医学院动物科学实验室进行的。
1. 供体肝脏采购
注意：肝脏供体是雌性家猪（Sus scrofa homeus），年龄为4-5个月大，平均体重约为50公斤，在手术前已经在动物研究机构隔离了至少10天。
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<ol>
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T., 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=Liver+transplantation:+Fifty+years+of+experience.">Liver transplantation: Fifty years of experience.</a> World Journal of Gastroenterology. 20 (18), 5363-5374 (2014).</li><li>Jakubauskas, M., 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=Machine+perfusion+in+liver+transplantation:+A+systematic+review+and+meta-analysis.">Machine perfusion in liver transplantation: A systematic review and meta-analysis.</a> Visceral Medicine. , (2021).</li><li>Serifis, N., 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=Machine+perfusion+of+the+liver:+A+review+of+clinical+trials.">Machine perfusion of the liver: A review of clinical trials.</a> Frontiers in Surgery. 8, 625394 (2021).</li><li>Ceresa, C. 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(65), e4143 (2012).</li><li>Yang, L., 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=A+rat+model+of+orthotopic+liver+transplantation+using+a+novel+magnetic+anastomosis+technique+for+suprahepatic+vena+cava+reconstruction.">A rat model of orthotopic liver transplantation using a novel magnetic anastomosis technique for suprahepatic vena cava reconstruction.</a> Journal of Visualized Experiments. (133), e56933 (2018).</li><li>Chen, X. -. C., 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=Reduced+complications+after+arterial+reconnection+in+a+rat+model+of+orthotopic+liver+transplantation.">Reduced complications after arterial reconnection in a rat model of orthotopic liver transplantation.</a> Journal of Visualized Experiments. (165), e60628 (2020).</li><li>Qian, S. G., Fung, J. 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Serie d: Sciences Naturelles. 260 (21), 5621-5623 (1965).</li><li>Calne, R. 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=Observations+of+orthotopic+liver+transplantation+in+the+pig.">Observations of orthotopic liver transplantation in the pig.</a> British Medical Journal. 2 (5550), 478-480 (1967).</li><li>Chalstrey, L. J., 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=Technique+of+orthotopic+liver+transplantation+in+the+pig.">Technique of orthotopic liver transplantation in the pig.</a> The British Journal of Surgery. 58 (8), 585-588 (1971).</li><li>Filipponi, F., Falcini, F., Benassai, C., Martini, E. <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+transplant+in+pigs:+Several+variations+of+the+surgical+technic.">Orthotopic liver transplant in pigs: Several variations of the surgical technic.</a> Il Giornale di Chirurgia. 10 (7-8), 374-378 (1989).</li><li>Spetzler, V. N., 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=Technique+of+porcine+liver+procurement+and+orthotopic+transplantation+using+an+active+porto-caval+shunt.">Technique of porcine liver procurement and orthotopic transplantation using an active porto-caval shunt.</a> Journal of Visualized Experiments. (99), e52055 (2015).</li><li>Oldhafer, K. J., Hauss, J., Gubernatis, G., Pichlmayr, R., Spiegel, H. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liver+transplantation+in+pigs:+A+model+for+studying+reperfusion+injury.">Liver transplantation in pigs: A model for studying reperfusion injury.</a> Journal of Investigative Surgery. 6 (5), 439-450 (1993).</li><li>Oldhafer, K. J., 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=Analysis+of+liver+hemodynamics+in+severe+ischemia+and+reperfusion+injury+after+liver+transplantation.">Analysis of liver hemodynamics in severe ischemia and reperfusion injury after liver transplantation.</a> Zentralblatt fur Chirurgie. 119 (5), 317-321 (1994).</li><li>Vogel, T., 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=Successful+transplantation+of+porcine+liver+grafts+following+48-hour+normothermic+preservation.">Successful transplantation of porcine liver grafts following 48-hour normothermic preservation.</a> PLoS One. 12 (11), 0188494 (2017).</li><li>Leal, A. J., 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=A+simplified+experimental+model+of+large-for-size+liver+transplantation+in+pigs.">A simplified experimental model of large-for-size liver transplantation in pigs.</a> Clinics. 68 (8), 1152-1156 (2013).</li><li>Schiefer, J., 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=Regulation+of+histamine+and+diamine+oxidase+in+patients+undergoing+orthotopic+liver+transplantation.">Regulation of histamine and diamine oxidase in patients undergoing orthotopic liver transplantation.</a> Scientific Reports. 10 (1), 822 (2020).</li><li>Esmaeilzadeh, M., 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=Technical+guidelines+for+porcine+liver+allo-transplantation:+A+review+of+literature.">Technical guidelines for porcine liver allo-transplantation: A review of literature.</a> Annals of Transplantation. 17 (2), 101-110 (2012).</li><li>Oldhafer, F., 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=Supportive+hepatocyte+transplantation+after+partial+hepatectomy+enhances+liver+regeneration+in+a+preclinical+pig+model.">Supportive hepatocyte transplantation after partial hepatectomy enhances liver regeneration in a preclinical pig model.</a> European Surgical Research. 62 (4), 238-247 (2021).</li><li>Stockmann, M., 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=The+LiMAx+test:+A+new+liver+function+test+for+predicting+postoperative+outcome+in+liver+surgery.">The LiMAx test: A new liver function test for predicting postoperative outcome in liver surgery.</a> HPB. 12 (2), 139-146 (2010).</li><li>Lapisatepun, W., Lapisatepun, W., Agopian, V., Xia, V. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Venovenous+bypass+during+liver+transplantation:+A+new+look+at+an+old+technique.">Venovenous bypass during liver transplantation: A new look at an old technique.</a> Transplantation Proceedings. 52 (3), 905-909 (2020).</li><li>Falcini, F., 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=Veno-venous+bypass+in+experimental+liver+transplantation:+portal-jugular+versus+caval-portal-jugular.">Veno-venous bypass in experimental liver transplantation: portal-jugular versus caval-portal-jugular.</a> Il Giornale di Chirurgia. 11 (4), 206-210 (1990).</li><li>Copca, N., 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=Experimental+liver+transplantation+on+pigs+--+Technical+considerations.">Experimental liver transplantation on pigs -- Technical considerations.</a> Chirurgia. 108 (4), 542-546 (2013).</li><li>Torres, O. J., 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=Hemodynamic+alterations+during+orthotopic+liver+experimental+transplantation+in+pigs.">Hemodynamic alterations during orthotopic liver experimental transplantation in pigs.</a> Acta Cirurgica Brasileria. 23 (2), 135-139 (2008).</li><li>Canedo, B. F., 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=Liver+autotransplantation+in+pigs+without+venovenous+bypass:+A+simplified+model+using+a+supraceliac+aorta+cross-clamping+maneuver.">Liver autotransplantation in pigs without venovenous bypass: A simplified model using a supraceliac aorta cross-clamping maneuver.</a> Annals of Transplantation. 20, 320-326 (2015).</li><li>Battersby, C., Hickman, R., Saunders, S. J., Terblanche, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liver+function+in+the+pig.+1.+The+effects+of+30+minutes'+normothermic+ischaemia.">Liver function in the pig. 1. The effects of 30 minutes' normothermic ischaemia.</a> The British Journal of Surgery. 61 (1), 27-32 (1974).</li><li>Kaiser, G. M., Heuer, M. M., Fr&#252;hauf, N. R., K&#252;hne, C. A., Broelsch, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=General+handling+and+anesthesia+for+experimental+surgery+in+pigs.">General handling and anesthesia for experimental surgery in pigs.</a> Journal of Surgical Research. 130 (1), 73-79 (2006).</li><li>Oike, F., 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=Simplified+technique+of+orthotopic+liver+transplantation+in+pigs.">Simplified technique of orthotopic liver transplantation in pigs.</a> Transplantation. 71 (2), 328-331 (2001).</li><li>Heuer, M., 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=Liver+transplantation+in+swine+without+venovenous+bypass.">Liver transplantation in swine without venovenous bypass.</a> European Surgical Research. 45 (1), 20-25 (2010).</li><li>Fondevila, C., 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=Step-by-step+guide+for+a+simplified+model+of+porcine+orthotopic+liver+transplant.">Step-by-step guide for a simplified model of porcine orthotopic liver transplant.</a> The Journal of Surgical Research. 167 (1), 39-45 (2011).</li></ol>

最近的技术发展，如机器灌注的引入，有可能彻底改变肝移植领域。为了将移植物修复或修饰概念转化为临床环境，大型动物的可重复移植模型是不可避免的。
在猪原位肝移植最初引入后，在过去的五十年中，几位作者一直致力于改进这些技术。所报道的手术方法之间的差异通常很小，涉及血管和胆道吻合、麻醉和围手术期管理。尽管如此，与目前临床肝移植的情况相反，?...

肝移植仍然是导致急性或慢性肝衰竭的各种不同疾病中生存的唯一机会。自1963年Thomas E. Starzl首次在人类中成功应用以来，肝移植的概念已发展成为全球应用的可靠治疗选择，这主要是由于对免疫系统的理解的进步，现代免疫抑制的发展以及围手术期护理和手术技术的优化1，2.然而，人口老龄化和对器官需求的增加导致献血者短缺，过去几十年中，来自扩展标准捐献者的边际移植物的使用增加，并出现了新的挑战。器官机器灌注的引入和广泛实施被认为为移植物修复和调节开辟了一系列可能性，并有助于缓解器官短缺和降低等待名单死亡率3，4，5，6。
为了评估这些概念及其在体内的效果，需要转化移植模型7。1983年，Kamada等人在大鼠中引入了一种有效的原位肝移植模型，该模型已被全球工作组广泛修改和应用8，9，10，11。小鼠原位肝移植模型在技术上要求更高，但在免疫可转移性方面也更有价值，并于1991年由钱等人首次报道12。尽管在可用性、动物福利和成本方面具有优势，但啮齿动物模型在临床环境中的适用性有限7。因此，需要大型动物模型。
近年来，猪由于其与人类的解剖和生理相似性，已成为用于转化研究的主要动物物种。此外，目前在异种移植领域的进展可能会进一步增加猪作为研究对象的重要性13，14。
Garnier等早在1965年就描述了猪肝移植模型15。几位作者，包括1967年的Calne等人和1971年的Chalsrey等人，随后报告了修改，最终导致了随后几十年内猪肝移植的安全可行的实验性概念16，17，18，19，20，21。
最近，不同的工作组使用猪原位肝移植技术提供了有关肝移植当前问题的数据，几乎总是包括主动或被动静脉静脉，即Porto-caval，旁路19，22。其原因是由于肠相对较大且门腔或腔腔分流较少（例如，缺乏无肝期），对下腔静脉和门静脉钳夹的物种特异性不耐受23。在人类受者中应用下腔静脉保留移植技术作为替代方案是不可行的，因为猪下腔静脉被肝组织包裹23。
然而，静脉-静脉旁路的使用进一步增加了已经要求苛刻的外科手术中的技术和后勤复杂性，因此可能会阻止工作组完全尝试实施该模型。除了搭桥术的直接生理和免疫学影响外，一些作者还指出了分流放置期间的显着发病率，例如失血或空气栓塞，以及需要同时进行脾切除术，这可能会影响植入后的短期和长期结果24，25。
以下协议描述了供体器官静态冷藏20小时后猪原位肝移植的简单技术，代表在植入过程中不使用静脉 - 静脉旁路的扩展标准供体条件，包括供体肝脏采购，背台准备，受体肝切除术和麻醉术前和术中管理。
该模型对于专注于术后即刻病程、缺血再灌注损伤、扩展标准供体器官的修复以及相关免疫机制的外科工作组应特别感兴趣。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Abdominal retractor</td>
			<td>No Company Name available</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Aortic clamp, straight</td>
			<td>Firma Martin</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Arterial Blood Sampler Aspirator (safePICOAspirator) 1.5 mL</td>
			<td>Radiometer Medical ApS</td>
			<td>956-622</td>
			<td></td>
		</tr>
		<tr>
			<td>Atropine (Atropinsulfat 0.5 mg/1 mL)</td>
			<td>B.Braun</td>
			<td>648037</td>
			<td></td>
		</tr>
		<tr>
			<td>Backhaus clamp</td>
			<td>Bernshausen</td>
			<td>BF432</td>
			<td></td>
		</tr>
		<tr>
			<td>Bipolar forceps, 23 cm&#160;</td>
			<td>SUTTER</td>
			<td>780222 SG</td>
			<td></td>
		</tr>
		<tr>
			<td>Bowl 5 L, 6 L, 9 L</td>
			<td>Chiru-Instrumente</td>
			<td>35-114327</td>
			<td></td>
		</tr>
		<tr>
			<td>Braunol Braunoderm</td>
			<td>B.Braun</td>
			<td>3881059</td>
			<td></td>
		</tr>
		<tr>
			<td>Bulldog clamp</td>
			<td>Aesculap</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Button canula</td>
			<td>Krauth + Timmermann GmbH</td>
			<td>1464LL1B</td>
			<td></td>
		</tr>
		<tr>
			<td>Calcium gluconate (2.25 mmol/10 mL (10%))</td>
			<td>B.Braun</td>
			<td>2353745</td>
			<td></td>
		</tr>
		<tr>
			<td>Cell Saver (Autotransfusion Reservoir)</td>
			<td>Fresenius Kabi AG</td>
			<td>9108471</td>
			<td></td>
		</tr>
		<tr>
			<td>Central venous catheter 7Fr., 3 Lumina, 30 cm 0.81 mm</td>
			<td>Arrow</td>
			<td>AD-24703</td>
			<td></td>
		</tr>
		<tr>
			<td>Clamp</td>
			<td>INOX</td>
			<td>B-17845&#160; /&#160; BH110&#160; / B-481</td>
			<td></td>
		</tr>
		<tr>
			<td>Clamp</td>
			<td>Aesculap</td>
			<td>AN909R</td>
			<td></td>
		</tr>
		<tr>
			<td>Clamp, 260 mm</td>
			<td>Fehling Instruments GMbH &#38;Co.KG</td>
			<td>ZAU-2</td>
			<td></td>
		</tr>
		<tr>
			<td>Clip Forceps, medium</td>
			<td>Ethicon</td>
			<td>LC207</td>
			<td></td>
		</tr>
		<tr>
			<td>Clip forceps, small</td>
			<td>Ethicon&#160;</td>
			<td>LC107</td>
			<td></td>
		</tr>
		<tr>
			<td>CPDA-1 solution</td>
			<td>Fresenius Kabi AG</td>
			<td>41SD09AA00</td>
			<td></td>
		</tr>
		<tr>
			<td>Custodiol (Histidin-Tryptophan-Ketogluterat-Solution)</td>
			<td>Dr.Franz K&#246;hler Chemie GmbH</td>
			<td>2125921</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissecting scissors</td>
			<td>LAWTON&#160; 05-0641&#160;</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissecting scissors, 180 mm</td>
			<td>Metzenbaum&#160;</td>
			<td>BC606R</td>
			<td></td>
		</tr>
		<tr>
			<td>Endotracheal tube 8.0 mm</td>
			<td>Covetrus</td>
			<td>800764</td>
			<td></td>
		</tr>
		<tr>
			<td>Epinephrine (Adrenalin 1:1000)</td>
			<td>InfectoPharm</td>
			<td>9508734</td>
			<td></td>
		</tr>
		<tr>
			<td>Falcon Tubes 50ml</td>
			<td>Greiner&#160;</td>
			<td>227 261 L</td>
			<td></td>
		</tr>
		<tr>
			<td>Femoralis clamp</td>
			<td>Ulrich&#160;</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Fentanyl 0.1mg</td>
			<td>PanPharma</td>
			<td>00483</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, anatomical</td>
			<td>Martin</td>
			<td>12-100-20</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, anatomical, 250 mm</td>
			<td>Aesculap</td>
			<td>BD052R</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, anatomical, 250 mm</td>
			<td>Aesculap</td>
			<td>BD032R</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, anatomical, 250 mm&#160;</td>
			<td>Aesculap</td>
			<td>BD240R</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, surgical</td>
			<td>Bernshausen</td>
			<td>BD 671</td>
			<td></td>
		</tr>
		<tr>
			<td>Forceps, surgical</td>
			<td>INOX</td>
			<td>B-1357</td>
			<td></td>
		</tr>
		<tr>
			<td>G40 solution</td>
			<td>Serag Wiessner</td>
			<td>10755AAF</td>
			<td></td>
		</tr>
		<tr>
			<td>Gelafundin ISO solution 40 mg/mL</td>
			<td>B. Braun</td>
			<td>210257641</td>
			<td></td>
		</tr>
		<tr>
			<td>Guidewire with marker</td>
			<td>Arrow</td>
			<td>14F21E0236</td>
			<td></td>
		</tr>
		<tr>
			<td>Haemostatic gauze (&#34;Tabotamp&#34;&#160; 5 x 7.5 cm)</td>
			<td>Ethicon</td>
			<td>474273</td>
			<td></td>
		</tr>
		<tr>
			<td>Heparin sodium 25,000IE</td>
			<td>Ratiopharm</td>
			<td>W08208A</td>
			<td></td>
		</tr>
		<tr>
			<td>Hico-Aquatherm 60</td>
			<td>Hospitalwerk</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Infusion Set Intrafix</td>
			<td>B.Braun</td>
			<td>4062981 L</td>
			<td></td>
		</tr>
		<tr>
			<td>Intrafix SafeSet 180 cm</td>
			<td>B.Braun</td>
			<td>4063000</td>
			<td></td>
		</tr>
		<tr>
			<td>Introcan Safety, 18 G&#160;</td>
			<td>B.Braun</td>
			<td>4251679-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Isofluran CP</td>
			<td>CP-Pharma</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Large-bore venous catheter, 7Fr.</td>
			<td>Edwards Lifesciences</td>
			<td>I301F7</td>
			<td></td>
		</tr>
		<tr>
			<td>Ligaclip, medium</td>
			<td>Ethicon</td>
			<td>LT200</td>
			<td></td>
		</tr>
		<tr>
			<td>Ligaclip, small</td>
			<td>Ethicon&#160;</td>
			<td>LT100</td>
			<td></td>
		</tr>
		<tr>
			<td>Material scissors</td>
			<td>Martin&#160;</td>
			<td>11-285-23</td>
			<td></td>
		</tr>
		<tr>
			<td>Methylprednisolone (Urbason solubile forte 250 mg)</td>
			<td>Sanofi</td>
			<td>7823704</td>
			<td></td>
		</tr>
		<tr>
			<td>Monopolar ERBE ICC 300</td>
			<td>Fa. Erbe</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>NaCl solution (0.9%)</td>
			<td>Baxter</td>
			<td>1533</td>
			<td></td>
		</tr>
		<tr>
			<td>Needle holder</td>
			<td>Aesculap</td>
			<td>BM36</td>
			<td></td>
		</tr>
		<tr>
			<td>Needle holder</td>
			<td>Aesculap</td>
			<td>BM035R</td>
			<td></td>
		</tr>
		<tr>
			<td>Needle holder</td>
			<td>Aesculap</td>
			<td>BM 67</td>
			<td></td>
		</tr>
		<tr>
			<td>Neutral electrode</td>
			<td>Erbe Elektromedizin GmbH T&#252;bingen</td>
			<td>21191 - 060</td>
			<td></td>
		</tr>
		<tr>
			<td>Norepinephrine (Sinora)</td>
			<td>Sintetica GmbH</td>
			<td>04150124745717</td>
			<td></td>
		</tr>
		<tr>
			<td>Omniflush Sterile Filed 10 mL</td>
			<td>B.Braun</td>
			<td>3133335</td>
			<td></td>
		</tr>
		<tr>
			<td>Original Perfusorline 300 cm</td>
			<td>B.Braun</td>
			<td>21E26E8SM3</td>
			<td></td>
		</tr>
		<tr>
			<td>Overhold clamp</td>
			<td>INOX</td>
			<td>BH 959</td>
			<td></td>
		</tr>
		<tr>
			<td>Overhold clamp</td>
			<td>Ulrich</td>
			<td>CL 2911</td>
			<td></td>
		</tr>
		<tr>
			<td>Pentobarbital sodium(Release 500 mg/mL)</td>
			<td>WDT, Garbsen</td>
			<td>21217</td>
			<td></td>
		</tr>
		<tr>
			<td>Perfusers</td>
			<td>B.Braun</td>
			<td>49-020-031</td>
			<td></td>
		</tr>
		<tr>
			<td>Perfusor Syringe 50 mL</td>
			<td>B.Braun</td>
			<td>8728810F</td>
			<td></td>
		</tr>
		<tr>
			<td>Petri dishes&#160; 92 x 17 mm</td>
			<td>Nunc</td>
			<td>150350</td>
			<td></td>
		</tr>
		<tr>
			<td>Poole Suction Instrument Argyle flexibel</td>
			<td>Covidien, Mansfield USA</td>
			<td>20C150FHX</td>
			<td></td>
		</tr>
		<tr>
			<td>Potassium chloride (7.45%)</td>
			<td>B.Braun</td>
			<td>4030539078276</td>
			<td></td>
		</tr>
		<tr>
			<td>Pressure measurement set</td>
			<td>Codan pvb Medical GmbH</td>
			<td>957179</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol (1%)</td>
			<td>CP-Pharma</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>S-Monovette 2.6 mL K3E</td>
			<td>Sarstedt</td>
			<td>04.1901</td>
			<td></td>
		</tr>
		<tr>
			<td>S-Monovette 2.9 mL 9NC</td>
			<td>Sarstedt</td>
			<td>04.1902</td>
			<td></td>
		</tr>
		<tr>
			<td>S-Monovette 7.5 mL Z-Gel</td>
			<td>Sarstedt</td>
			<td>11602</td>
			<td></td>
		</tr>
		<tr>
			<td>Sartinski clamp</td>
			<td>Aesculap</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel&#160; No.11</td>
			<td>Feather Safety Razor Co.LTD</td>
			<td>02.001.40.011</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>INOX&#160;</td>
			<td>BC 746</td>
			<td></td>
		</tr>
		<tr>
			<td>Seldinger Arterial catheter</td>
			<td>Arrow</td>
			<td>SAC-00520</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium bicarbonate (8.4%)</td>
			<td>B.Braun</td>
			<td>212768082</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterilization Set (&#34;ProSet Preparation Kit CVC&#34;)</td>
			<td>B.Braun</td>
			<td>4899719</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterofundin ISO solution</td>
			<td>B.Braun</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction</td>
			<td>Dahlhausen</td>
			<td>07.068.25.301</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction Aesculap Securat 80</td>
			<td>Aesculap</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction catheter</td>
			<td>ConvaTec</td>
			<td>5365049</td>
			<td></td>
		</tr>
		<tr>
			<td>Sultamicillin (Unacid: 2000 mg Ampicillin/1000 mg Sulbactam)</td>
			<td>Pfizer</td>
			<td>DL253102</td>
			<td></td>
		</tr>
		<tr>
			<td>Suprapubic urinary catheter, &#34;bronchialis&#34;, 50 cm</td>
			<td>ConvaTec</td>
			<td>UK&#160; 1F02772</td>
			<td></td>
		</tr>
		<tr>
			<td>Suprasorb (&#34;Toptex lite RK&#34;)</td>
			<td>Lohmann &#38; Rauscher</td>
			<td>31654</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture Vicryl 3-0</td>
			<td>Ethicon</td>
			<td>VCP 1218 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture Vicryl 4-0</td>
			<td>Ethicon</td>
			<td>V392H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene 4-0</td>
			<td>Ethicon</td>
			<td>7588 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene 5-0, double armed</td>
			<td>Ethicon&#160;</td>
			<td>8890 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene 5-0, single armed</td>
			<td>Ethicon&#160;</td>
			<td>8720 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene 6-0, double armed</td>
			<td>Ethicon&#160;</td>
			<td>7230 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene 6-0, single armed</td>
			<td>Ethicon</td>
			<td>EH 7406 H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Prolene: blau 3-0&#160;</td>
			<td>Ethicon</td>
			<td>EH 7499H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Safil 2/0</td>
			<td>Aesculap</td>
			<td>C 1038446</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture, Terylene 0</td>
			<td>Serag Wiessner</td>
			<td>353784</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringe 2 mL, 5 mL, 10 mL, 20 mL</td>
			<td>B.Braun</td>
			<td>4606027V</td>
			<td></td>
		</tr>
		<tr>
			<td>TransferSet &#34;1D/X-double&#34; steril 330 cm</td>
			<td>Fresenius Kabi AG</td>
			<td>2877101</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound Butterfly IQ+</td>
			<td>Butterfly Network Inc.</td>
			<td>850-20014</td>
			<td></td>
		</tr>
		<tr>
			<td>Ventilator &#34;Oxylog Dr&#228;ger Fl&#34;</td>
			<td>Dr&#228;ger Medical AG</td>
			<td>No Catalog Number available</td>
			<td></td>
		</tr>
		<tr>
			<td>Yankauer Suction</td>
			<td>Medline</td>
			<td>RA19GMD</td>
			<td></td>
		</tr>
		<tr>
			<td>Zoletil 100 mg/mL&#160; (50 mg Zolazepam, 50 mg tiletamin)</td>
			<td>Virbac</td>
			<td>794-861794861</td>
			<td></td>
		</tr>
	</tbody>
</table>

porcine liver transplantation without veno-venous bypass as an extended criteria donor model

肝移植被认为是治疗各种致命肝脏疾病的金标准。然而，慢性移植失败、器官供体持续短缺以及边缘移植物使用增加等未解决的问题要求改进当前的概念，例如器官机器灌注的实施。为了评估移植物修复和调节的新方法，需要转化模型。关于与人类的解剖学和生理学相似性以及异种移植领域的最新进展，猪已成为移植模型中使用的主要大型动物物种。在1965年由Garnier等人首次引入猪原位肝移植模型后，在过去的60年中已经发表了一些修改。
由于特定的解剖学特征，在无肝期进行静脉-静脉搭桥被认为是减少导致血流动力学不稳定和围手术期死亡率的肠充血和缺血的必要条件。然而，旁路的实施增加了程序的技术和后勤复杂性。此外，相关并发症，如空气栓塞、出血和需要同时进行脾切除术，以前已有报道。
在该协议中，我们描述了不使用静脉 - 静脉旁路术的猪原位肝移植模型。静态冷藏20小时后对供体肝脏的植入 - 模拟扩展标准供体条件 - 表明这种简化的方法可以在没有显着血流动力学改变或术中死亡率的情况下进行，并且定期摄取肝功能（由胆汁产生和肝脏特异性CYP1A2代谢定义）。优化的手术技术以及复杂的麻醉容量和血管加压药管理确保了这种方法的成功。
该模型应该对专注于术后即刻病程、缺血再灌注损伤、相关免疫机制和扩展标准供体器官修复的工作组特别感兴趣。

该方案中提出的技术在整个手术过程中的血流动力学稳定性和动物存活率以及术后移植物功能方面提供了可靠且可重复的结果。
最近，我们将该模型应用于缺血再灌注损伤的研究和治疗干预，以减轻术后立即的不利影响。取回和静态冷藏20小时后，以所述方式植入肝脏移植物（平均重量为983.38g）。在门静脉再灌注并以规定的时间间隔采样血液和胆汁以及肝脏和胆管组织采样?...

Watch this Scientific Journal Video about Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model at JoVE.com

Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model

在该协议中，描述了在植入过程中不使用静脉 - 静脉旁路的情况下对供体器官静态冷藏20小时后猪原位肝移植的模型。该方法使用简化的手术技术，最大限度地减少无肝期，并采用复杂的容量和血管加压药管理。

无静脉-静脉旁路术的猪肝移植作为扩展标准供体模型

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft ...

目前肝移植的问题需要实施大型动物模型。该协议描述了不使用静脉 - 静脉旁路术的猪原位肝移植技术。这种技术大大降低了程序的后勤和技术复杂性。此外，通过在静态冷藏20小时后移植肝脏，我们的模型模拟了扩展标准供体条件。首先将麻醉的供体猪置于仰卧位，并用松紧带将四肢固定在手术台的底部。用防腐剂擦洗皮肤，并用无菌窗帘覆盖动物。确认花瓣反射丧失后，使用单极烧灼术从剑突开始进行中线剖腹手术，并使用剪刀和双极烧灼切断镰状和三角韧带。充分进行肝脏清扫后，用剪刀将横膈膜的左侧切开 5 至 10 厘米的距离，以定位降主动脉的胸段。包围并放置 3-0 多丝结扎，不要拧紧。用剪刀切开横膈膜的右侧部分 5 到 10 厘米的距离，并确定下腔静脉。将肠重新定位到供体的左上角，并使用剪刀在5至10厘米的距离内横向切开腹膜后空间。在腹主动脉周围放置两个 3-0 多丝结扎。一个髂骨分叉的颅骨和一个大约 3 厘米的颅骨，没有收紧。在下肝下腔静脉周围放置另一个结扎，不要收紧。收紧腹主动脉周围位于尾部的第一结扎。在第二个结扎的颅骨上闭塞腹主动脉后，用剪刀在两个结扎之间做一个横向切口。将套管插入切口并用剩余的结扎固定。用剪刀切断颅上下腔静脉，远离右心房。失血约1， 500至2， 000毫升后，通过结扎交叉夹住降主动脉的胸段并开始顺行灌注。收紧放置在下肝下静脉周围的结扎。切开结扎的颅骨血管并插入手术吸引器。在大约10至15分钟的过程中用3，500毫升保存溶液灌注后，切断供体猪下方的肝上肝静脉，然后在左肾静脉水平切断下肝下腔静脉。在两个 3-0 多丝结扎之间切断胰腺组织的胆管颅骨以避免胆汁溢出，然后切断胰腺的门静脉颅骨。钝器准备后找到乳糜泻动脉，然后沿着腹主动脉背侧。切除相应的主动脉段以创建用于植入的贴片。切除下部超级肝静脉周围的横膈膜，并用剪刀切断剩余的粘连。取出肝脏并放在冰上。进行胆囊切除术或收紧胆囊管周围的结扎，然后用至少 20 毫升的保存溶液冲洗胆总管。将灌注插管放入门静脉，并用500毫升保存溶液冲洗移植物。将移植物放入放在冰上的无菌碗中。切除主动脉段和肝动脉的淋巴组织，从而用夹子、结扎或缝合线识别和闭塞动脉侧支和淋巴管。以类似的方式处理门静脉。仅在植入和植入时进行血管缩短和主动脉瓣贴片的准备，以考虑个体解剖情况。识别下肝腔静脉，并在切除周围膈肌组织后在两条膈静脉周围缝合。将麻醉的受体猪置于仰卧位。如前所述，进入腹腔并使用剪刀和双极烧灼切断麻醉动物的镰状和三角形韧带。充分进行肝脏清扫后，将上静脉和肝下腔静脉包围在靠近肝实质的地方。切开覆盖肝十二指肠韧带的浅表腹膜层，并在进入肝实质之前识别肝动脉。使用双相烧灼或放置夹子、结扎或缝合线进行解剖。解剖并切断两个结扎之间的胆囊管连接处下方的胆总管。识别门静脉并靠近肝实质。切开左右膈肌之间的无血管层后识别腹主动脉。通过切除周围组织来准备主动脉吻合术。通过将创伤性血管钳夹放在门静脉上进行受者肝切除术，并在靠近肝实质的地方切断门静脉，然后切断肝下腔静脉。将非创伤性血管钳夹放在包括周围膈肌在内的上尿腔静脉上，同时尾部回缩肝脏并切断靠近肝实质的血管。从腹腔中取出受体肝脏。将供体肝脏放入腹腔，将供体或受体下腔静脉缩短至足够长度，同时避免吻合口扭结或张力过大。放置一条 5-0 单丝缝合线作为支撑线，适应供体和受体上肝腔静脉下部的右角。用5-0单丝双臂跑线从血管的左角开始吻合的背侧。到达右角时取下支撑线并用夹子固定运行缝合线，然后继续吻合口的腹侧，再次从血管的左角开始。完成吻合的腹侧后，用多个结收紧缝合线，不要限制血管直径，以避免狭窄。如前所述，使用 6-0 单丝双臂缝合线对供体和受体门静脉进行血管吻合。通过移除血管钳夹开始门静脉再灌注，阻塞受体门静脉，并在引流约 200 至 400 毫升血液后用血管钳夹闭塞供体下肝下腔静脉。慢慢移除阻塞受体上肝下腔静脉的血管钳夹，并寻找活动性出血。缩短供体和/或受体下腔静脉。然后对供体和受体进行下肝下腔静脉的血管吻合术。夹住腹主动脉并切开以适合贴片后，在切口或贴片的颅角处用 6-0 单丝双臂跑线开始主动脉吻合术。当到达尾角时，用夹子固定运行缝合线，并从颅角开始再次完成吻合。用多个结拧紧缝合线，并在检查所有血管吻合后慢慢取下血管夹。将导管置于胆总管中，并用单个结扎将其固定。通过调整肌肉筋膜和皮肤，用跑步缝合线暂时关闭腹部，并用粘膜或窗帘覆盖腹部以避免热损失。平均手术时间为103.50分钟，其中平均期和肝期为27.13分钟。只有两名受者经历了超过30分钟的无肝期，而所有受者在门静脉再灌注后4小时都显示出乳酸血清浓度下降。接受者需要在无肝期之前和整个期增加去甲肾上腺素浓度，以将平均动脉压稳定在60毫米汞柱或更高。在这个脆弱的时期，低肾上腺素浓度同时用于增加心输出量。植入后，平均动脉压和所需剂量的血管加压药保持稳定。门静脉再灌注后6小时获得的LiMAx值与肝脏供体在器官获取前测量的值相当，除了一个无肝期为34分钟的受体。该模型作为病情检查的读数可能特别有趣，重点是缺血和再灌注损伤的机制以及扩展标准供体器官的修复。

Research

JoVE Journal

Medicine

Orthotopic Liver Transplantation in Rats

大鼠原位肝移植

Clinical progress in the field of liver transplantation has been largely supported by animal models1,2. Since the publication of the first orthotopic rat ...

科研

医学

Using Quantitative Real-time PCR to Determine Donor Cell Engraftment in a Competitive Murine Bone Marrow Transplantation Model

采用实时定量PCR检测供体细胞植入一个具有竞争力的小鼠骨髓移植模型

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules ...

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

使用Active波尔图腔静脉分流术猪肝脏采购和原位移植技术

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

Ex Situ Normothermic Machine Perfusion of Donor Livers

Ex Situ Normothermic Machine Perfusion of Donor Livers

供肝易地常温灌注机

In contrast to conventional static cold preservation (0-4 &#176;C), ex situ machine perfusion may provide better preservation of donor livers. Continuous ...

Cardiopulmonary Bypass in a Mouse Model: A Novel Approach

小鼠体外循环模型: 一种新方法

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization ...

Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse

小鼠静脉内膜氧化术

The use of extracorporeal membrane oxygenation (ECMO) has increased substantially in recent years. ECMO has become a reliable and effective therapy for ...

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

正交心脏移植的临床前猪模型

Fifty-years following the first successful report, cardiac transplantation remains the gold-standard treatment for eligible patients with advanced heart ...

Murine Precision-Cut Liver Slices as an Ex Vivo Model of Liver Biology

毛利精密切肝片作为肝脏生物学的Ex Vivo模型

Understanding the mechanisms of liver injury, hepatic fibrosis, and cirrhosis that underlie chronic liver diseases (i.e., viral hepatitis, non-alcoholic ...

Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP

ESLP幼猪模型中的左肺原位移植

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. ...

A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

一种猪异位心脏移植方案，用于向心脏同种异体移植物提供治疗药物

Cardiac transplantation is the gold standard treatment for end-stage heart failure. However, it remains limited by the number of available donor hearts ...