Main Complications Leading to Unsuccessful Intestinal Transplantation in Rats. Multicenter Study

STRINGA P ; ANDRES A; HERNANDEZ OLIVEROS F; PASTOR OLIVER C; ABATE JC; NAVARRO ZORRAQUINO M; LAUSADA N; GONDOLESI G

Simposio; http://journals.lww.com/transplantjournal/Citation/2015/06001/Abstracts_from_the_XIV_International_Small_Bowel.1.aspx; 2015

Intestinal Transplant Association

Introduction: Intestinal transplantation in rats is a highly complexmicrosurgical technique. Several surgical and technical complicationscan lead to recipient mortality and transplant failure. Therefore,microsurgeons should be trained not only in microsurgery but alsoin handling of rodents to achieve recipient-prolonged survival (morethan 5 pos-transplant days).Aim: to report the most common surgical complications associatedwith orthotopic and heterotopic intestinal transplantation in rats, inorder to identify the critical points of the procedure and prevent them.Materials and methods: a retrospective multicenter study was performed.Data were obtained from 4 research centers with extensiveexperience in this experimental technique. All isolated intestinal engraftmentswere performed using end-to-side arterial (donor SMAwith recipient infrarenal aorta) and vein (donor portal vein with recipientinfrarenal vena cava) anastomosis. In all cases, cold ischemiatime was no more than 90 min. We have only considered unsuccessfultransplants, defined as intraoperative deads or those occurredwithin the initial 5 post-transplant days.Results: 303 complications from 265 unsuccessful intestinal transplantprocedures were reported (average of 1.14 complications / surgery);20.5% and 79.5 % of the reported complications occured inthe donor or recipient surgery respectively. Excessive surgical time(more than 60 min) (29/62); inappropriate infusion of the preservationsolution in the intestinal graft (18/62) and severe hemorrhage (12/62)were the 3 most common complications described in the donor surgery.Twenty five different complications were registered in the recipientsurgery. Bleeding from the arterial anastomosis (36/241), portal veinstenosis (26/241), bleeding from the vein anastomosis (25/241) andarterial stenosis (12/241) were the most frequent intraoperative complications.After anesthetic recipient recovery, several complications can occur,including hypothermia, volvulus, paralysis of hind limbs, abdominalhemorrhage, prolapse of the graft, dehiscence of the enteric anastomotic,peritonitis and undetermined cause, among others, were reported.Conclusion: intestinal transplantation in rats requires a fine surgicaltechnique, only one complication can lead to failure. Recipient surgeryis more complex than the donor operation, and vascular anastomosisrepresents the key point to success. Adecuate perioperativemanagement of the animal is mandatory to assure survival after thischallenging surgical procedure.References:1. Impact of ishemia-reperfusion injury on long survival rate in intestinaltransplantation in rats.2. Apoptosis and CD8 and CD54 cell expression in rat small boweltransplantation.3. Ischemic preconditioning of the graft for intestinal transplantationin rats.4. Technical aspects of experimental intestinal transplant.