Clinical noninvasive evaluation of simultaneous pancreas-kidney transplants with the combined use of gammagraphy, Doppler ultrasound, and serum markers

Establishment of a pig model with enteric and portal venous drainage of pancreatoduodenal transplantation

AIM: To establish the pig model of pancreatoduodenal transplantation with enteric drainage (ED) and portal venous drainage (PVD).

METHODS: Forty-six hybrid Landrace pigs were divided into two groups (donors and recipients) randomly, and pancreatoduodenal allotransplantation was performed. Donors were perfused via abdominal aorta without clamping the portal venous outflow with UW solution at 80100 cm H2O after heparinization. Whole pancreato-duodenal grafts were harvested with segments of abdominal aorta and portal vein, and shaped under 4 °C UW solution. Then, end-to-end anastomosis was performed with the donor iliac artery bifurcation Y graft to the recipient superior mesenteric artery and celiac artery. Furthermore, type I diabetes model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesentery vein. Meanwhile, end-to-side anastomosis was performed with the donor common iliac artery bifurcation Y graft to the recipient abdominal aorta, and side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. Levels of plasma glucose, insulin and glucagon were measured during the operation and on the 1^st, 3^rd, 5^th, and 7^th d after operation.

RESULTS: Pancreatoduodenal allotransplantation was performed on 23 pigs of which 1 died of complication of anesthesia. The success rate of operation was 95.6%. Complications of operation occurred in two cases in which one was phlebothrombosis with an incidence of 4.6%, and the other was duodenojejunal anastomotic leak with an incidence of 4.6%. The level of plasma glucose decreased within 30 min, after removal of pancreas and recovered on the 2^nd d after operation. The level of plasma insulin and glucagon increased within 30 min after removal of pancreas and recovered on the 2^nd d after operation. Rejection occurred on the 1st d and reached the worst level on the 7^th d after transplantation, without change of plasma insulin and glucagon or clinical symptoms of rejection.

CONCLUSION: Pancreatoduodenal transplantation in pigs can treat type I diabetes. ED and PVD can keep the function of endocrine in normal. The technique of pancreatoduodenal transplantation with ED and PVD may pave the way for the further application of pancreas transplantation in clinic.