Modified technique for combined liver-small bowel transplantation in pigs

Abstract

Aim: As the conventional combined liver-small bowel transplantation is complicated with many postoperative complications, the aim of this study was to describe a modified technique for the combined liver-small bowel transplantation with preservation of the duodenum, partial head of pancreas and hepatic biliary system in pigs.

Methods: Composite liver/small bowel allotransplantations were undertaken in 30 long-white pigs. The graft included liver, about 3 to 4 m proximal jejunum, duodenum and partial pancreatic head. Vessels reconstructions included subhepatic vena cava-vena cava anastomosis, aorta-aorta anastomosis and portal-splenic vein anastomosis.

Results: Without immunosuppressive treatment, the median survival time of the animals was 6 days (2 to 12 days), and about 76.9 % (20/26) of the animals survived for more than 4 days after operation.

Conclusion: The modified technique is feasible and safe for the composite liver/small bowel transplantation with duodenum and pancreas preserved in pigs. And also this technique can simplify the operation and decrease possible postoperative complications.

Figure 1

Composite liver/small bowel transplantation (D = donor, R = recipient, AO = aorta, HA = hepatic artery, PV = portal vein, SB = small bowel, IVC = inferior vena cava, SV = splenic vein, P = pancreas, JO = jejunum ostomy, AS1 = aorta-aorta anastomosis, AS2 = subhepatic vena cava- vena cava anastomosis, AS3 = portal-splenic vein anastomosis, AS4 = proximal jejuno-jejunal anastomosis, AS5 = distal jejuno-ileal anastomosis).