Surgical guide including innovative techniques for orthotopic liver transplantation in the rat: Key techniques and pitfalls in whole and split liver grafts

Authors T. Hori, S. Uemoto, X. Zhao, F. Chen, A-M T. Baine, L.B. Gardner, N. Ohashi, F. Conkle, M. Castanedes-Casey, V.R. Phillips, L.G. Rousseau, M. Murray, N. Kamo, J.H. Nguyen.


Background. Although the techniques of orthotopic liver transplantation (OLT) and split OLT (S-OLT) have been well documented in the rat by established microsurgeons, the surgical skills required for this model limits its use by some investigators. Furthermore, alternative artificial OLT/S-OLT models are of limited use in the liver transplantation field. Herein, we describe detailed surgical procedures for our rat OLT/S-OLT model and our surgical learning curves. Methods. We studied the anatomical findings, including inflow and outflow, in 100 rats following OLT/S-OLT, and determined the operator learning curves for this model. We also investigated the discrepancy between survival rates and the rates of reliable samples in OLT and S-OLT, respectively, because surgical issues destroy all experiments. Results. Learning curve data indicated that 50 cases were required for operator training plus sufficient animals to start a study. In making split-liver grafts, thoughtful consideration of inflow and outflow are crucial for successful S-OLT. Our results showed that some complications necessarily disrupt all of the experiments, and we should omit unreliable samples if any complications and/or unreasonable histology are observed, especially at early post-operative period after S-OLT. Conclusion. Although OLT/S-OLT in rats required advanced skills, this is the only liver transplantation model that provides clinically relevant and reliable results.
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