Modified Multivisceral Transplantation with Native Spleen Removal in Rats
05 October 2017
16 January 2018
23 February 2018 (eFirst)
Background Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Our aim is to describe in detail some technical modifications of MMVTx to obtain long-term survival.
Materials and Methods Syngeneic (Lewis–Lewis) heterotopic MMVTx was performed in 16 male rats (180–250 g). All procedures were performed under isoflurane anesthesia. The graft consisted of stomach, duodenopancreatic axis, spleen, and small bowel. The vascular pedicle consisted of a conduit of aorta, including the celiac trunk and the superior mesenteric artery (SMA), and the portal vein (PV). The engraftment was performed by end-to-side anastomosis to the infra-renal cava vein and aorta. After reperfusion, the graft was accommodated in the right side of the abdomen, and a terminal ileostomy performed. The native spleen was removed.
Results Donor and recipient time was 39 ± 4.4 minutes and 69 ± 7 minutes, respectively; venous and arterial anastomosis time was 14 ± 1 minutes and 12.3 ± 1 minutes, respectively. Total ischemia time was 77.2 ± 7.9 minutes. Survival was 75% (12/16), six were sacrificed after 2 hours, and six were kept alive for long-term evaluation (more than 1 week).
Conclusion Long-term survival is reported after heterotopic MMVTx in rats. The heterotopic MMVTx with native spleen removal would potentially improve the existent models for transplant research. The usefulness of this model warrants further confirmation in allogeneic experiments.
- 1 Cruz Jr RJ, Costa G, Bond GJ. , et al. Modified multivisceral transplantation with spleen-preserving pancreaticoduodenectomy for patients with familial adenomatous polyposis “Gardner's Syndrome”. Transplantation 2011; 91 (12) 1417-1423
- 2 Takahashi H, Delacruz V, Sarwar S. , et al. Contemporaneous chronic rejection of multiple allografts with principal pancreatic involvement in modified multivisceral transplantation. Pediatr Transplant 2007; 11 (04) 448-452
- 3 Torres C, Sudan D, Vanderhoof J. , et al. Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr 2007; 45 (02) 204-212
- 4 Goulet O, Joly F, Corriol O, Colomb-Jung V. Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transplant 2009; 14 (03) 256-261
- 5 Goulet OJ. Intestinal failure-associated liver disease and the use of fish oil-based lipid emulsions. World Rev Nutr Diet 2015; 112: 90-114
- 6 Grant D, Abu-Elmagd K, Mazariegos G. , et al; Intestinal Transplant Association. Intestinal transplant registry report: global activity and trends. Am J Transplant 2015; 15 (01) 210-219
- 7 Galvão FH, Waisberg DR, Cruz Jr RJ, Chaib E, Carneiro D'Albuquerque LA. Modified multivisceral transplantation in the rat. Transplantation 2013; 96 (02) e3-e4
- 8 Stringa P, Andres AM, Lausada N. , et al. Small bowel transplantation in rats, a multicener experience summarizing the pitfalls to be overcome. Trends Transplant 2017; 10 (01) 1-7
- 9 Stringa P, Romanin D, Lausada N. , et al. Gut permeability and glucose absorption are affected at early stages of graft rejection in a small bowel transplant rat model. Transplant Direct 2017; 3 (11) e220
- 10 Andres AM, Santamaría ML, Ramos E. , et al. Graft-vs-host disease after small bowel transplantation in children. J Pediatr Surg 2010; 45 (02) 330-336
- 11 Wu G, Selvaggi G, Nishida S. , et al. Graft-versus-host disease after intestinal and multivisceral transplantation. Transplantation 2011; 91 (02) 219-224
- 12 Murase N, Demetris AJ, Woo J. , et al. Graft-versus-host disease after brown Norway-to-Lewis and Lewis-to-Brown Norway rat intestinal transplantation under FK506. Transplantation 1993; 55 (01) 1-7
- 13 Galvao FH, Murase N, Todo S. , et al. Cytokine profile in graft-versus-host disease after small bowel transplantation. Transplant Proc 1996; 28 (05) 2455
- 14 Galvao FH, Ye Q, Doughton C. , et al. Experimental animal model of graft-versus-host disease (GVHD) after small-bowel transplantation: characteristics of the model and application to developing treatment strategies. Transplant Proc 1997; 29 (1-2): 700
- 15 Hernández F, Zou Y, López G. , et al. Is portal venous outflow better than systemic venous outflow in small bowel transplantation? Experimental study in syngeneic rats. J Pediatr Surg 2005; 40 (02) 336-340
- 16 Wang Z, Hernandez F, Pederiva F. , et al. Ischemic preconditioning of the graft for intestinal transplantation in rats. Pediatr Transplant 2011; 15 (01) 65-69
- 17 Zou Y, Hernandez F, Burgos E. , et al. Bacterial translocation in acute rejection after small bowel transplantation in rats. Pediatr Surg Int 2005; 21 (03) 208-211
- 18 Andres AM, Santamaria M, Hernandez-Oliveros F. , et al. Difficulties, guidelines and review of developing an acute rejection model after rat intestinal transplantation. Transpl Immunol 2016; 36: 32-41
- 19 Foell D, Becker F, Hadrian R, Palmes D, Kebschull L. A practical guide for small bowel transplantation in rats-review of techniques and models. J Surg Res 2017; 213 (213) 115-130
- 20 Murase N, Demetris AJ, Furuya T, Todo S, Fung JJ, Starzl TE. Comparison of the small intestine after multivisceral transplantation with the small intestines transplanted with portal or caval drainage. Transplant Proc 1992; 24 (03) 1143-1144
- 21 Abu-Elmagd KM. Preservation of the native spleen, duodenum, and pancreas in patients with multivisceral transplantation: nomenclature, dispute of origin, and proof of premise. Transplantation 2007; 84 (09) 1208-1209
- 22 Hernandez F, Andres AM, Encinas JL. , et al. Preservation of the native spleen in multivisceral transplantation. Pediatr Transplant 2013; 17 (06) 556-560