Peri-operative management of swine orthotopic liver transplantation

Abstract

Objective To summarize the peri-operative management experience of swine orthotopic liver transplantation. Methods From September 2013 to August 2016, 62 liver transplantations (LT) were performed with 124 Bama mini-pigs, including 30 cases of standard LT, 10 cases of split LT, 11 cases of donation after cardiac death (DCD) LT, 5 cases of extracorporeal membrane oxygenation (ECMO) repaired DCD LT and 6 cases of normothermic machine perfusion (NMP) repaired DCD LT. Results For all of the 124 pigs, 3 underwent tracheotomy after failed tracheal intubation. Anhepatic time was (22.3±2.6) min (range 18-26 min), similar among the 62 different type LTs. Mean arterial pressure could be mainted ≥ 50 mmHg (1 mmHg=0.133 kPa) through rapid colloid solution infusion without administration of any vasoactive substances.5 receipts of split LTs died during the operation because of bleeding. 14 cases died after operation. 3 were of standard LT, all in the very beginning period when we first build this animal model, 1 died of abdominal bleeding, the other 2 died of bile leak induced severe infection.11 cases from the DCD LT died of model related hepatic failure. Post-operative 5-day survival rates of standard, split, DCD, ECMO-repaired DCD, NMP-repaired DCD were 90%, 50%, 0%, 100%, 100%, respectively. Conclusion Precise peri-operative management is essential for successful swine orthotopic liver transplantation. Skilled trachea intubation and tracheotomy procedure, accurate liquid management, well-practiced animal model are the key points, and anhepatic period should be shortened as much as possible. Key words: Pig; Liver transplantation; Peri-operative management