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. 2025 May 31:5:100060.
doi: 10.1016/j.intf.2025.100060. eCollection 2025 Jan-Mar.

Standardizing training protocol of an intestinal transplantation model: A learning curve study

J Azpiroz  1 , J C Abate  1 , A M Andres Moreno  2 , J E Moreira  3 , F Hernandez Oliveros  2   4 , J C Raimondi  1   5 , G Gondolesi  6 , N R Lausada  1 , P Stringa  1   7
Affiliations

Standardizing training protocol of an intestinal transplantation model: A learning curve study

J Azpiroz et al. Intest Fail. .

Abstract

Rodent models of intestinal transplantation are crucial for advancing our understanding of various biological processes related to the procedure, including ischemia-reperfusion injury, acute cellular rejection and immunological tolerance, among others. These models also provide a platform for developing strategies and therapeutics aimed at improving long-term survival, with the ultimate goal of translating laboratory findings into clinical applications. With over twenty years of experience in intestinal transplantation in rodents, our team currently achieves a survival rate of 83 % in orthotopic transplants and 85 % in heterotopic transplants-success rates comparable to those reported by leading research groups in the field. This manuscript outlines the key steps involved in achieving successful results in rat intestinal transplantation models. It covers the entire process, from basic microsurgical training and graft procurement to implantation and postoperative care of the recipient. We hope this work will serve as a valuable guide for research groups seeking to establish these experimental transplantation models in their own laboratories.

Keywords: Intestines; Microsurgery; Rats; Research; Transplant.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gabriel E. Gondolesi, MD- editor of Intestinal Failure If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Donor surgery: positioning of the small intestine (SI) and cecum glands (CG) before the rotation maneuver (A), and after the rotation (B). Selection of the distal end of the graft (DEG) and identification of the portal vein (PV) (C) Selection of the proximal end of the graft (PEG) (D). Macroscopic appearance of the graft after a proper lavage (E). Identification of the superior mesenteric artery (SMA) and the PC of the graft during the cold ischemia period (F).
Fig. 2
Fig. 2
Recipient surgery: A- end-to-side venous anastomosis between the recipient vena cava (RVC) and the donor portal vein (DVP). In addition, the recipient aortic artery (RAA), the native intestine (NI) and the transplanted intestine (TI) can be seen. B- arterial anastomosis between the donor superior mesenteric artery (SMA) and the RAA. The venous anastomosis (VA) is also observed. C- macroscopic appearance of the reperfused graft.
Fig. 3
Fig. 3
A- exteriorization of the graft through the abdominal wall by making a proximal stoma (PO) and a distal stoma (DO) in the heterotopic ITx model. B and C- enteroanastomosis between the transplanted intestine (TI) and the native intestine (NI) in the orthotopic model using 7–0 monofilament nylon as suture material.
Fig. 4
Fig. 4
Surgical times of the donor surgery (A); each point represents a procedure and each shape a surgeon (Sx). Fig. B shows the average times it takes each SX to perform the surgery.
Fig. 5
Fig. 5
Preservation time impacts graft architecture during cold ischemia (A) and the reperfusion phase (B). Histological damage was quantified using the Park scale. On the other hand, the damage caused to the graft during cold ischemia phase has an impact on the transplanted animal’s survival, as shown in Figure C, when evaluating recipient animals that received intestines preserved for less than 60 minutes (continuous line) and animals that received grafts preserved for 4 hours (dotted line).
Fig. 6
Fig. 6
The learning curves for the recipient surgery (A), the artery anastomosis (B), the vein anastomosis (C). Each point represents a different procedure and each shape a different surgeon (Sx). And the average time of each Sx for performing the recipient surgery (D) the vein anastomosis (E), the artery anastomosis (F) and the average time for the recipient differentiating between the orthotopic and heterotopic models (G).
Fig. 7
Fig. 7
The complications reported by the surgeons.
See this image and copyright information in PMC

References

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