Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2015 Vol. 23 No 1

EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2015.1.5   |  

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. Marys 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 recipients 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
References
  1. Thiede A, Brieler HS, Deltz E, Engemann R, Poser H. Experimental microsurgery in rats. Zentralbl Chir. 1978;103(21):1397-409. [Article in German].
  2. Benetti L, Bassi C, Zamboni G, Radin S, Falconi M, Girelli R, Elio A, Briani GF, Cavallini G, Pederzoli P. Pancreaticoduodenal graft in the rat: an original microsurgical technique. Eur Surg Res. 1989;21(3-4):162-67.
  3. Lee S, Scott M, de Macedo AR. Pancreaticoduodenal transplantation in the rat. A technique update. Transplantation. 1986 Sep;42(3):327-29.
  4. Lee S, Tung KS, Koopmans H, Chandler JG,, Orloff MJ. Pancreaticoduodenal transplantation in the rat. Transplantation. 1972 Apr;13(4):421-25.
  5. Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. 2005 Aug;19(4):433-55.
  6. International Pancreas Transplant Registry http://www.iptr.umn.edu.
  7. Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC.Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967 Jun;61(6):827-37.
  8. Agnes S, Castagneto M. [Transplantation of the isolated pancreas in rats. Technical aspects]. [Article in Italian] Minerva Chir. 1980 May 31;35(10):683-87.
  9. Di Cataldo A, Puleo S, Li Destri G, Guastella T, Trombatore G, La Greca G, Leone F, Latteri F, Rodolico G.. Pancreas transplantation in the rat using Lee's technique: a reliable model in experimental microsurgery. J Invest Surg. 1989;2(2):159-67.
  10. Königsrainer A, Habringer C, Krausler R, Margreiter R. A technique of pancreas transplantation in the rat securing pancreatic juice for monitoring. Transpl Int 1990;3(3):181.
  11. Toledo-Pereyra LH, Sutherland DE.Richard Carlton Lillehei: transplant and shock surgical pioneer. J Invest Surg. 2011;24(2):49-52.
  12. Lugagne PM, Reach G, Houry S, Peuchemaure M, Rouchette J, Huguier M.Portal versus peripheral venous drainage in segmental pancreatic transplantation in diabetic rats. Transplantation. 1989 Mar;47(3):420-23.
  13. Timmermann W, Schang T, Stoffregen C, Schubert G, Thiede A. Development and perspectives of experimental pancreas transplantation in the rat. Microsurgery. 1990;11(2):133-39.
  14. Yoon JH, Jung SI, Cho C, Gil MC, Kim CG.Effects of simultaneous kidney-pancreaticoduodenal transplantation on diabetes-induced renal insufficiency in rats. Microsurgery. 2001;21(4):173-78.
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 surgeons 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. Marys Hospital, Vechta, Germany.
Contacts | ©Vitebsk State Medical University, 2007