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Khirurgii

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Year 2015 Vol. 23 No 1

EXPERIMENTAL SURGERY

E. MATEVOSSIAN 1, I. SNOPOK 2, P. HEILER 1, F. MELCHIOR 1, J. NäHRIG 1,3, G.S. LUPPA 4, E.A. ANASTASIEVA 4, D. DOLL 5

MICROSURGICAL TECHNIQUE OF COMBINED PANCREAS AND KIDNEY TRANSPLANTATION IN EXPERIMENTAL MODEL

University Clinic "rechts der Isar", Munich Technical University1, Munich,
St Lukas Hospital 2, Solingen,
Institute of General Pathology and Pathologic Anatomy 3, Munich,
Germany,
SBEE HPE "Novosibirsk State Medical University" 4,
The Russian Federation
Catholic hospital Oldenburger Munsterland, St. Mary’s Hospital 5, Vechta,
Germany

Objectives. The experimental model testing of a combined pancreas/kidney transplantation more suitable to the technique used in present-day clinical practice that can be used for fundamental transplantation studies.
Methods. Donor rats (8) underwent en bloc pancreatectomy and nephrectomy. The revascularization of the transplanted pancreatic islet was performed via aorta abdominalis-tube with the donor superior mesenteric artery artery mesenterica superior to the recipient abdominal aorta and the recipient's inferior vena cava anatomosis with the donor portal vein segment. Exocrine outflow of secret of pancreas transplant implemented via en bloc explanted duodenal segment of the donor, anastomosed side-to-side to the recipient’s jejunum (terminales Ileum/Jejunum).
The renal vessels anastomosed side-to-side to the abdominal aorta and subhepatic segment of the inferior vena cava. The urethra was implanted by patch technique. Postoperatively, serum parameters were monitored daily. Biopsy samples were taken for histopathology examination via a minilaparotomy approach on the 5th, 8th and 12th day.
Results. In the early postoperative period 7 out of 8 recipients underwent the combined PKTx without serious surgical complications. One thrombosis of the portal vein led to the organ failure. Blood glucose levels were normal by the 2nd postoperative day. On the 5th day the transplanted duodenal segment showed slight villous atrophy, and the kidneys were well perfused without signs of vascular complications. The anastomosis between urethra and bladder was leak-proof in all 8 cases.
Conclusion. Surgical technique optimization and time reduction of the surgical intervention permitted to achieve a regular function of both transplants at relatively low recipients’ morbidity. The proposed PKTx experimental model can be used for fundamental studies.

Keywords: transplantation, pancreas, kidney, allograft, surgical technique, experimental model
p. 5-11 of the original issue
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Address for correspondence:
Priv.-Doz. Dr. med. habil. Edouard Matevossian, MD, Department of Surgery,
Klinikum "rechts der Isar", Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.
e-mail: edouard.matevossian@tum.de
Information about the authors:
Matevossian E. MD, professor of surgery, University Clinic "rechts der Isar", Munich Technical University, Munich.
Snopok I. A surgeon’s assistant , St Lukas Hospital, Solingen.
Heiler P. A 5-year student of the medical faculty, University Clinic "rechts der Isar", Munich Technical University, Munich.
Melchior F. A 5-year student of the medical faculty, University Clinic "rechts der Isar", Munich Technical University, Munich.
Nährig J. MD, a pathologist, University Clinic "rechts der Isar", Munich Technical University, Institute of general pathology and pathologic anatomy , Munich.
Luppa G.S. A 5-year student of the pediatric faculty of SBEE HPE "Novosibirsk State Medical University".
Anastasieva E.A. A 5-year student of the pediatric faculty of SBEE HPE "Novosibirsk State Medical University".
Doll D. MD, professor of surgery, Catholic hospital Oldenburger Munsterland, St. Mary’s Hospital, Vechta, Germany.
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