Serial Experimental Studies Of Abdominal Organ Cluster Transplantation

Part OneEstablishment of a simplified orthotopic abdominal organ cluster transplantation technique without venovenous bypass in pig modelObjective To establish a simplified orthotopic abdominal organ cluster transplantation technique in pig model without using venovenous bypass (VVB).Methods Fifty outbred large-white pigs were allocated 25 pairs. The donor and the corresponding recipient were sibling pigs. After in situ perfused through abdominal aorta and superior mesenteric vein, the multivisceral allograft was procured from the donor and tailored at the back table . The multivisceral allograft including liver, pancreas, stomach, duodenum and proximal jejunum about two-miters long were en bloc transplanted to the recipient after the resection of entire foregut and midgut. Vascular reconstruction was restored by end-to-end anastomosis of suprahepatic vena cava, end-to-side anastomosis of abdominal aorta, andend-to-end anastomosis of infrahepatic vena cava. Gastrointestinal continuity was restored by end-to-side anastomosis of stomach fundus to the esophagus, and the terminal jejunum was exteriorized as a jejunostomy. The VVB was not used.Results The model was established in 25 pigs, 19 pigs survived after operation. Without using immunosuppressant, the survival time of the animals was from 2h to 146h.Conclusion Despite with highly morbidity and mortality, the simplified orthotopic abdominal organ cluster transplantation without VVB is technically feasible in pig model, and it will make for our future clinical practice and further experimental study of the abdominal organ cluster transplantation.Part TwoEstablishment of a improved heterotopic abdominal organ cluster transplantationtechnique in rat modelObjective To establish a modified heterotopic abdominal organ cluster transplantation technique in rat model.Methods 130 SD rats were used in our experiments and 65 heterotopic abdominal organ cluster transplantations were be performed. In the donor' s operation, first colon and spleen, then left hepatic lobe and middle hepatic lobe were resected. After in situ perfused through abdominal aorta, the multivisceral allograft including liver, pancreas, duodenum, proximal jejunum about 40 centimeters long, aortic conduit, and vena cava was procured from the donor and tailored at the back table. In the recipient' soperation, the implantation was performed as follow: 1.end—to-side anastomosis between the aortic conduit and abdominal aorta. 2. end-to-sida anastomosis between infrahepatic vena cava. 3. end-to-side anatomosis between terminal jejunum and duodenum.Results 65 transplantations were carried out in which the operation achievement ratio in the last 20 cases was 75% (15/20). The longest survival time was three weeks.Conclusion The model of heterotopic abdominal organ cluster transplantation in rat was successfully established. It can be used to study the relevant research work of abdominal organ cluster transplantation in rat.Part ThreeThe preliminary observation with anti-CD52 monoclonal antibody induction in rat heterotopic abdominal organ cluster transplantation modelObjective To observe the effectiveness of Campath-IG induction on the acute rejection after heterotopic abdominal organ cluster transplantation in rat model.Methods 36 wistar rats and 45 SD rats were used in our experiment. They were divided into five groups. Group A: without tranplantation. Group B: transplantation without using immunosuppressant. Group C: transplantation with low dose of CsA (1mg/kg/d, subcutaneous injection, dayO-day6). Group D: transplantation with usual dose of CsA (10mg/kg/d, subcutaneous injection, day0-day6). Group E: transplantation with Campath-1G (0.3mg/kg, intravenous injection in the operation) induction plus low dose of CsA(1mg/kg/d, subcutaneous injection, day0-day6). The level of serum IFN-Vand IL-2 in the recipient's peripheral blood was examined and compared in day3, day7 and dayl4 after operation between groups by ESLIA method. Histologic pathology was also examined and compared.Results The level of serum IL-2 rose in group B and group C, and was declined in group D and group E, there was significant difference (p<0.05), The same thing was happened in level of serum IFN-γ . Compared with that of group B and group C, the level of serum IFN-γ in group D and group E also had a significant declined (p<0.05). The pathological check of allografts at the same check point realed that: Compared with that of group B and group C, the incidence of acute rejection in group D and group E was decreased, the severity of acute rejectioin was also to lightened.Conclusion Campath-1G induction and low-dose CsA immunosuppression seems to not increase incidence of acute rejection in the rat heterotopic abdominal organ transplantation model.