Jochmans I, Lerut E, Heedfeld V, Wylin T, Pirenne J, Monbaliu D
Department of Surgery, Abdominal Transplant Surgery, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
Transplant Proc. 2009 Oct;41(8):3417-21. doi: 10.1016/j.transproceed.2009.09.024.
Several porcine models have been employed to study mechanisms of warm ischemia, cold ischemia, and ischemia reperfusion injury, but the technical/surgical aspects of these models and their possible pitfalls have not been fully described in detail. The goal of the present study was to develop and optimize a porcine kidney autotransplantation model.
Eleven female pigs (24-51 kg) underwent a left ureteronephrectomy. The procured kidney was flushed with 500 mL of histidine-tryptophan-ketoglutarate preservation solution and subsequently cold stored in University of Wisconsin preservation solution. An autotransplantation was performed 18 hours later, following contralateral nephrectomy. Serum creatinine and urine production were assessed posttransplantation. Pigs were sacrificed at 10 days posttransplantation.
Nine pigs showed functioning grafts, immediately producing urine posttransplantation. The serum creatinine values in these pigs followed a bell-shaped curve with peak values at day (D)2-D3. Two renal artery thromboses were observed; the venous anastomosis was prone to stenosis in 6 cases. These technical complications influenced posttransplant observations. Renal artery thrombosis resulted in anuria and increased serum creatinine levels. A stenotic renal vein was associated with a greater peak of serum creatinine. These complications were prevented by modifying the surgical technique accordingly.
We developed and optimized a reproducible model of porcine kidney autotransplantation. Herein we have demonstrated the importance of a proper surgical anastomotic technique to avoid inflow or outflow obstruction that might jeopardize posttransplant kidney function. This clinically relevant model offers the possibility to study various aspects related to kidney preservation without the interference of an allogeneic immune response.
已有多种猪模型用于研究热缺血、冷缺血及缺血再灌注损伤的机制，但这些模型的技术/手术方面及其可能存在的缺陷尚未得到充分详细的描述。本研究的目的是建立并优化一种猪肾自体移植模型。
11只雌性猪（体重24 - 51千克）接受了左输尿管肾切除术。获取的肾脏用500毫升组氨酸 - 色氨酸 - 酮戊二酸保存液冲洗，随后置于威斯康星大学保存液中冷藏。18小时后，在对侧肾切除术后进行自体移植。移植后评估血清肌酐和尿量。猪在移植后10天处死。
9只猪的移植肾显示功能良好，移植后立即产生尿液。这些猪的血清肌酐值呈钟形曲线，在第2 - 3天达到峰值。观察到2例肾动脉血栓形成；6例静脉吻合口易发生狭窄。这些技术并发症影响了移植后的观察结果。肾动脉血栓形成导致无尿和血清肌酐水平升高。肾静脉狭窄与血清肌酐的更高峰值相关。通过相应修改手术技术预防了这些并发症。
我们建立并优化了一种可重复的猪肾自体移植模型。在此我们证明了正确的手术吻合技术对于避免可能危及移植后肾功能的流入或流出梗阻的重要性。这种与临床相关的模型为研究与肾脏保存相关的各个方面提供了可能性，而不受同种异体免疫反应的干扰。
