Alsebayel Mohammed, El-Sheikh Yasser M, Al-Mohanna Falah H, Al-Abbad Saleh I, Al-Jammali Ahmed, Alsebayel Yazeed M, Al-Bahli Hamad M
General Surgery, Alhabib Medical Group, Riyadh, SAU.
Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU.
Cureus. 2023 Jul 17;15(7):e42002. doi: 10.7759/cureus.42002. eCollection 2023 Jul.
Experimental animal liver transplantation is the initial step, before the application of the procedure on humans. Canine and swine transplantation were used to perfect the technical aspects of the procedure. Small animals such as rats were mainly utilized to study the metabolic and immunological aspects of liver transplantation. In this paper, we describe our experience with attempting liver transplantation in a sheep animal model.
The animal model used for both donor and recipient was outbred male weanling sheep of Naimi strain ( Awassi). They weigh between 25 and 35 kg. They were put under general anesthesia. Harvested livers were kept in cold storage. Recipients underwent hepatectomy, after construction of an active portal systemic bypass using a Medtronic pump. The implantation was done with caval replacement and direct portal anastomosis. The hepatic artery with its attachments to the aortal was anastomosed directly to the recipient aorta.
Twelve pairs (24 sheep) were utilized for donor and recipient surgery. Donor surgery was completed successfully in all 12 cases. Recipient surgery was not completed in three cases, when animals were lost in the implantation phase, before reperfusion mainly due to uncontrolled bleeding, resulting in hemodynamic instability. We also lost five recipients immediately after reperfusion, mainly due to post-perfusion bleeding and hemodynamic instability. Four recipients stayed alive after the implantation.
We demonstrated the feasibility of using sheep as an animal model for liver transplantation. We described the similarities of sheep liver to that of humans, as well as the technical difficulties. This model is suitable in situations where other well-established models are not available for cultural or religious reasons. Further refinement in the technical aspects will be needed, as well as investigation of the biochemical outcome and long-term survival.
实验性动物肝移植是该手术应用于人类之前的初始步骤。犬类和猪的肝移植用于完善手术的技术环节。诸如大鼠等小型动物主要用于研究肝移植的代谢和免疫方面。在本文中，我们描述了在绵羊动物模型中尝试进行肝移植的经验。
用于供体和受体的动物模型均为外源性雄性断奶纳伊米品系（阿瓦西）绵羊。它们体重在25至35千克之间。对其实施全身麻醉。摘取的肝脏进行冷藏保存。受体在使用美敦力泵构建主动门体分流后接受肝切除术。通过腔静脉置换和直接门静脉吻合进行植入。将与主动脉相连的肝动脉直接吻合至受体主动脉。
12对（24只绵羊）用于供体和受体手术。所有12例供体手术均成功完成。3例受体手术未完成，动物在植入阶段、再灌注前因出血无法控制导致血流动力学不稳定而死亡。另外，5例受体在再灌注后立即死亡，主要原因是灌注后出血和血流动力学不稳定。4例受体在植入后存活。
我们证明了使用绵羊作为肝移植动物模型的可行性。我们描述了绵羊肝脏与人类肝脏的相似之处以及技术难点。在因文化或宗教原因无法获得其他成熟模型的情况下，该模型是适用的。需要在技术方面进一步完善，同时对生化结果和长期存活情况进行研究。
