Experimental And Clinical Research Of Simultaneous Pancreas-kidney Transplantation With Enteric Drainage

Part 1 Establishment of the Model of Simultaneous Pancreas-kidney Transplantation with Enteric Drainage and Systemical Venous Drainage or Portal Venous Drainage in Pigs Objective: To establish of the model of simultaneous pancreas-kidney transplantation with enteric drainage and systemical venous drainage or portal venous drainage in pigs and undergo imitated operation and make preliminary observation of acute rejection of allograft to make the base for clinical application and research. Methods: Harvesting multiple abdominal organs together was conducted in 10 donors. 10 recipients' pancreastomy and ligation AtV of double kidney were performed and the donor's kidney artery ,veins and ureter were anastomosed end-to-side to the recipient 's left common iliac arteries, vein and bladder respectively. The donor's aorta including abdominal arteries and superior mesenteric artery , portal vein were anastomosed to the recipient right common iliacartery and vein in 5 pigs respectively.The other 5 pigs,aorta in a end-to-side fashion were anastomosed to right common iliac artery and the portal vein was anastomosed end-to-side to the superior mesenteric vein. The pancreas exocrine secretion drainage was established with side-to-side anastomoses between the donor duodenum and the recipient jejunum . The immunoinhibitor was not used after operation. Recipients were killed 10 days after transplantation and autopsy was conducted. Results: SPK was successfully performed in 9 recipients, and one died in the operation. Serum creatinine increased slightly 2 days after operation and then increased gradually;The hemodiastase increased slightly 2 days after operation and increased significantally from 5 to 10 days after operation;The fasting blood glucose increased significantally 9 days afer operation.The urinary volume of recipients after operation began to become mostly normal, but urine volume dcreased dramatically when grafts' functions were losed or 1 -2 days before animals died, and at the same time hemodiastase increased. After killed or died, the color of grafts' pancreas became dim. By autopsy, it was proved that destruction of graft was caused by acute rejection. Conclusion: The model of simultaneous pancreas-kidney transplantation with enteric drainage and systemical venous drainage or portal venous drainage in pigs was successfully established, which is signigicant in clinical application and basic research of SPK.Part 2 The Effect of Portal Venous Drainage (PVD) and Systemic Venous Drainage (SVD) on Its Endocrine Function after Segmental Pancreas Autotransplantation Objective:To study the effect of the type of venous drainage of the graft on its endocrine function in two groups of pigs after segmental pancreas autotransplantation. Methods: Group 1 comprised 10 pigs with portal venous drainage and group 2 comprised 10 pigs with systemic venous drainage. The graft consisted of body and tail of the pancreas. The pigs were totally pancreatectomized. The pancreatic duct was occluded by neoprene injected into the duct. One week before and 1 month after transplantation, intravenous glucose tolerance tests (IVGTT) were performed. Plasma glucose (PG), insulin (INS), C-peptide, glucagons (GLU), and pancreatic poiypeptide (PP) were measured during the tests. All pigs had normal fasting PG 1 month after PanTx. In the PVD group, INS level was normal during the tests after PanTx, while in the SVD group a nonsignificant rise in INS level was recorded compared with that before transplantation. A significant difference (P<0.05) in INS levels was present 1 mon. after PanTx between the two groups. Pigs with PVD showed a higher (PO.05) C-peptide level than pigs with SVD during IVGTT. The initial fall in PP during IVGTT recorded in all pigs before transplantation was totally lost after transplantation in both groups. During the tests, PP remained steady and significantly lower than the pretransplantation levels in both groups. A significantly higher GLU level during the IVGTT was observed in SVD compared with PVD 1 month after PanTx (PO.05). Conclusion: It is concluded that the mode of delivery of...