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Bernardo F. Canedo, Flavio H. Galvao, Liliana Ducatti, Lucas S. Nacif, Sergio Catanozi, Wangles V. Soler, Eleazar Chaib, Luiz A. D'Albuquerque, Wellington Andraus
(Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil)
Ann Transplant 2015; 20:320-326
The pig is an essential model for liver transplantation research and training. However, it develops hemodynamic instability during the anhepatic phase, requiring a short anhepatic phase or an extracorporeal circulation not appropriate for training purposes because it increases the risk of intraoperative complications. In this article we describe an economical and reproductive experimental model for training surgeon fellows in liver transplantation, without veno-venous bypass, using a supraceliac aortic cross-clamping maneuver.
MATERIAL AND METHODS: After liver liberation, we cross-clamped the supraceliac aorta and cross-clamped and divided the infrahepatic inferior vena cava (IVC), bile duct (BD), hepatic artery (HA), portal vein (PV), and suprahepatic IVC. We rapidly removed and flushed the liver ex situ, repositioned it orthotopically, and performed anastomosis in suprahepatic IVC, infrahepatic IVC and PV, reperfusing the liver. Lastly, we anastomosed the HA and BD. We also performed pulmonary artery catheter exams and recovery blood samples serially before and after graft reperfusion (beginning of anesthesia = basal; 5 min after reperfusion and 120 min after reperfusion = end-point) for hemodynamic and metabolic assessment.
RESULTS: Transplantation fellows were able to perform the operations assisted by a senior surgeon. The median procedure time was 211 min (188–233 min). One pig died due to hemorrhage and 5 remained alive for up to 2 h after liver reperfusion, achieving at this time normal hemodynamic and metabolic parameters.
CONCLUSIONS: This model is suitable for training and experimentation, avoids venovenous bypass, is low cost, avoids immunological reaction, and prevents hemodynamic and metabolic complications.