The Experiment Of Simultaneous Pancreas-kidney Transplantation With Portal Venous Drainage In Animals

1. Establishment Of Simultaneous Pancreas-Kidney Transplantation Models With Portal Venous And Excrine External Drainage In Pigs. Objective To establish simultaneous pancreas-kidney transplantation ( SPKT) models with portal venous and exocrine external drainage in pigs, study the surgical skill, accumulate experience and discuss its feasibility. Methods 16 landrace swine were randomly divided into two groups used as donor and recipient. After the donor was anaesthetized , we entered the abdomen through a large "+" size incision , then separated the pancreas and kidneys. The donor's whole pancreas, segmental duodenum, two kidney and spleen were symphysially resected after heparinized and perfused through abdominal aorta in situ with 0~4℃ HCA solution. Then shear the portal vein , superior mesenteric vein, left renal vein and abdominal aorta. We anastomosed the left kidney vein and the inferior mesenteric vein of the grafts by end-to-end. The stump of duodenum was closed after perfused with 4℃ metronidazole. The recipient's anaesthetic procedure was identical with the donor's. The abdomen was entered through a slitting midline incision, the superior mesenteric vein and abdominal aorta were exposed 3 cm long. A end-to-sideanastomosis between portal vein of the graft and inferior mesenteric vein of the recipient was performed firstly, So do as the abdominal aorta of allograft and abdominal aorta of recipient. Intubate T tubes in duodenum and Ventricle drainage tube in ureter and drain outside. These leaft for two-stage operation. While all these were done, we closed the abdomen. After the operation, the swine was kept warm, given antibiotics and support therapy. Results 2 cases died immediately after operation. 6 cases succeeded. The grafts recovered excellent blood circulation, there was no leak and thrombus, and its function were also normal. The average survival time was 12±2.9 days. Conclusion In this experiment, we established the large animal models of SPKT with portal venous and excrine external drainage. The adept surgical skills is the basis of SPKT, and it is the key to reduce the early complication.2. A Randomized Trial in Simultaneous Pancreas-Kidney Transplantation: Portal Versus Systemic Venous Drainage of the Pancreas Allograft.Objectives To compare the SPKT who underwent portal venous drainage and systemic venous drainage and find out their difference.Methods 32 landrace swine were randomly divided into two groups , including systemic venous drainage group (SVD) and portal venous drainage group(PVD). we established the SPKT animal models. In SVD group, the portal vein of the graft was anastomosed to the recipient's superior mesenteric vein. In PVD group, the portal vein of the graft was anastomosed to the recipient's inferior venacava. Then we joined abdominal aorta of allograft to abdominal aorta of recipient by anatomosis, intubated T tubes in duodenum and Ventricle drainage tube in ureter and drained outside. These leaft for two-stage operation. After the transplantation, the swine was kept warm, given antibiotics and support therapy. In postoperative 5th day ,we opened the recipient's abdomen to get some the graft tissue for pathological examination, Apoptosis cells of grafts were monitored by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling ( TUNEL).Results We finished the operation successfully, the graft recovered it's circulation and function after transplantation. There is no significant difference (p>0.05) between two groups in the observation, including achievement ratio, complication, survival time, early acute rejection and graft apoptosis. Conclusion There is no evidence prove that the transplantation with portal venous drainage will increase the surgical risk , neither do the early acute rejection.