Experimental Study And Clinical Application On Simultaneous Kidney-pancreaticoduodenal Transplantation

Experimental study and clinical application on simultaneous kidney-pancreaticoduodenal transplantationABSTRACT1.Experimental study in pig model of simultaneous kidney-pancreaticoduodenal transplantation with bladder drainageObjectives To establish a model of simultaneous kidney-pancreaticoduodenal transplantation (SPKT) with bladder drainage in pigs, and to assess the value of the markers for detecting early rejection and observe pathological changes of the grafts. Methods Thirty mongrel pigs were used as donors or recipients. For donors?operation, with aortic cannulation, 4 ~C hyperosmotic citrate adenine (HCA) solution was perfused in situ, with the pressure of 80cm water column. About 300m1 of cold LICA solution was perfused. Perfusion was stopped as soon as the effluent from the portal vein was clear, and pancreas, duodenum, two kidneys became blanched. Then the whole pancreas, duodenum, spleen, bilateral kidneys and ureters were removed en bloc, and kept in 0-4 慍 I-JCA immediately. For the preparation of the graft, the abdominal aorta was made into one segment containing celiac axis, superior mesenteric artery and left renal artery. The portal vein was then anastomosed with left renal vein directly or left renal vein holding inferior vena cava button, depending on the diameter of distal portal vein. The duodenum was rinsed with metronidazole and then its ends were closed. For recipients?procedure, the whole pancreas was removed firstly. The abdominal aorta and inferior vena cava were freed by ligating the lumber arteries and veinsat the same level from renal allery to common iliac edery. An ovalopening was made on the anterior wall of the recipient abdominal aorta.The caliber was similar to the diameter of the proximal end of thedonor abdominal aorta. An end to side anastomosis was performedbetween donor aorta and recipient aorta. The portal vein wasanastomosed to the inferior vena cava in the same procedure. Theduodenum allograft was then anastomosed to the host's bladder in aside to side fashion. The uroterostomosis of the graft was perfOrmed.Finally the graft spleen was removed. Urine amylase (UA)concentration, fasting blood glucose and urine volume of kidneyallograft were monitored, and pathological change of graft wasobserved. No immunosuppression was administered to the recipienis.Results Of l5 recipiellts, 2 pigs died of disturbance of illtemalenviron-ment and anastomotic bleeding respectively. The remaining l3recipients were survived a mean of 9.5 t 2.7 days, and two of themwere sacrificed on seventh day and ninth day respectively3 because ofsignificant decrease in UA concentration, and urine volume of thekidney graft with fasting blood glucose increase. The graft turned to beswollen and dark on macroscopy The microscopy examination showedacute rejection with tissue necrosis. The destruction of the graft wasinduced by acute rejection and evaluated by urine amylase, fastingblood glucose and urine volume of the kidney graft. The recipientsusually began to defecate three to four days postoperation, and thenallowed feeding. The animals presellted listlessness, hypodynamia,anorexia after seven to nine days surgery. And the weight droppedrapidly. A swollen graft could be palpated in the abdomen, then theanimals died within one to two days. The change of urine amylaseconcelltfation was prior to those of fasting blood glucose and urinevolume of the kidney a1lograft. The degree of rejection of kidneyallograft was more severe than that of pancreas and duodenumallograft.Conclusions The established model in pigs fOr simultaneous kidneyand pancreaticoduodenal tfansplantation was reliable. Urine amylasewas sensitive marker fOr diagnosis of early acute rejection in SPKTwith bladder drainage. The pathological change of kidney allograft wasmore severe than that of pancreas and duodenum.2. Experimcntal studics on grafts harvesting, prep8ration andpreservation for combined kidney and pancr...