Surgical technique for combined intestine-auxiliary liver transplantation in rats: Development of a new microsurgical model

Combined liver-intestine transplantation is an evolving procedure, and auxi liary liver transplantation has several advantages over standard orthotopic liver transplantation. We present a new model of combined intestine-auxili ary liver transplantation in rats. Total small bowel and 60% liver were har vested en bloc. An aortic segment that contained the celiac axis and superi or mesenteric artery ensured blood supply to the graft. Venous drainage of the grafted intestine was achieved via the intact portal vein of the graft. The infrahepatic vena cava was cut at different levels during the modifica tion period and at the oblique level of the left renal vein in consecutive series. Revascularization was accomplished by end-to-side anastomosis of th e aorta and of the infrahepatic vena cava. The recipient small bowel was re sected and the intestine continuity restored by anastomosis. Total operatio n time averaged 130 min. The overall survival rate of 3 months in the conse cutive series was 80% (16/20). Exploratory laparatomy and histologic study in 3 rats on 90 days after transplantation revealed normal and viable graft s. Liver function was normal and both grafted liver and intestine showed no rmal histologic architectures in 5 rats observed for 12 months after transp lantation. The present model is reproducible and allows preclinical researc h on several aspects of experimental combined intestine-auxiliary liver tra nsplantation. (C) 2001 Wiley-Liss, Inc.