Multivisceral transplantation in pigs: a model for research and training

Objective: To present a model for research and training inmultivisceral transplantation in pigs. Methods: Eight LargeWhite pigs (four donors and four recipients) were operated. Themultivisceral transplant with stomach, duodenum, pancreas,liver and intestine was performed similarly to transplantation inhumans with a few differences, described below. Anastomoseswere performed as follows: end-to-end from the supra-hepaticvena cava of the graft to the recipient juxta diaphragmatic venacava; end-to-end from the infra-hepatic vena cava of the graftto the inferior (suprarenal) vena cava of the recipient; and endto-side patch of the aorta of the graft to the infrarenal aortaof the recipient plus digestive reconstruction. Results: Theperformance of the multivisceral transplantion was possible inall four animals. Reperfusions of the multivisceral graft led to asevere ischemia-reperfusion syndrome, despite flushing of thegraft. The animals presented with hypotension and the need forhigh doses of vasoactive drugs, and all of them were sacrificedafter discontinuing these drugs. Conclusion: Some alternativesto minimize the ischemia-reperfusion syndrome, such as the useof another vasoactive drug, use of a third pig merely for bloodtransfusion, presence of an anesthesia team in the operatingroom, and reduction of the graft, will be the next steps to enableexperimental studies.