Source: Liu, W. J. et al., Orthotopic Kidney Auto-Transplantation in a Porcine Model Using 24 Hours Organ Preservation and Continuous Telemetry. J. Vis. Exp. (2020).
This video describes orthotopic kidney auto-transplantation in a porcine model. This surgical procedure involves the transplantation of an animal's kidney graft at its original anatomical location. The model is used to investigate new treatments for end-stage kidney diseases in humans.
All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.
1. Basic techniques and common procedures
2. Contralateral nephrectomy and orthotopic kidney auto-transplantation
Figure 1: Study flowchart and protocol.
Abbreviations used: POD-postoperative day; ECG-electrocardiography.
Figure 2: Animal housing facility with real-time and continuous telemetry monitoring of up to 6 animals.
(A) Schematic blueprint of our facility suitable for the housing and telemetry monitoring of up to 6 animals. The size of the single holding boxes was determined based on the guidelines of the EU Directive 2010/63 and ETS 123 Appendix A. Panels A-E show representative images of the organization of our facility. (B) Animal room for the housing of 6 animals. (C) Observation room with a PC used for the continuous registration of telemetry data. (D) Real-time video and thermal footage of the animals. (E) Individual holding ensuring acoustic and olfactory contact of the animals with their companions to avoid social isolation.
Figure 3: Orthotopic kidney auto-transplantation and anatomical variations and reconstruction possibilities.
(A, B) The steps of the orthotopic kidney auto-transplantation model in case of a "standard" vascular anatomy. (C) Variation 1: while one larger vein comes with the donor kidney, there are two veins on the recipient side. Management: the smaller vein is closed by a ligature and the anastomosis is performed end to end between the renal veins. (D) Variation 2: while one larger vein comes with the donor kidney, there is no suitable recipient vessel on the contralateral side (e.g., size mismatch). Management: end to side anastomosis of the renal vein to the inferior vena cava. (E) Variation 3: two similar-sized veins on both sides. Management: reconstruction by two venous anastomoses. (F) Variation 4: while two similar-sized veins come with the donor kidney, there is no suitable recipient vessel on the contralateral side. Management: end to side anastomosis of the renal vein to the inferior vena cava in the case of two renal veins. (G) Variation 5: a donor kidney comes with a vein showing an early bifurcation, while there is one large vein on the contralateral side. Management: end-to-end anastomosis of the short common channel of the donor renal vein with one large vein on the recipient side. (H) Variation 6: while the donor kidney comes with a single renal vein with an early bifurcation, there is no suitable recipient vessel on the contralateral side. Management: end to side anastomosis of the short common channel of the donor renal vein to the inferior vena cava. This figure depicts a handful of the more frequent variations and is not statistically comprehensive in terms of all variations possible in German landrace pigs. Abbreviations used: KG-kidney graft; RK-right kidney; IVC-inferior vena cava; AO-aorta.
Figure 4: Representative color Doppler ultrasound images, directly after orthotopic kidney auto-transplantation and abdominal closure.
(A) Color Doppler ultrasound is performed directly following the implantation of the kidney and abdominal closure, to ensure good arterial and venous perfusion of the kidney graft and to screen for potential iatrogenic vascular kinking. Ultrasound was also used daily and on-demand, based on the clinical performance of the animal to screen for various problems. (B-E) Representative ultrasound images of a kidney graft following implantation. The image of the kidney graft with and without color Doppler (B, C) shows an excellent arterial (D) and venous perfusion (E). This figure shows representative images from the same animal.
The authors have nothing to disclose.
Anesthesia materials, drugs and medications | |||
Atropine sulfate solution for injection, 100mg | Dr. Franz Köhler Chemie GmbH, Bensheim, Germany | 1821288 | parasympatholytic agent, premedication |
Bepanthen ointment for eyes and nose | Bayer Vital AG, Leverkusen, Germany | 1578675 | eye ointment |
BD Discardit II syringes, 2ml, 5ml, 10ml,20ml | Becton Dickinson GmbH, Heidelberg, Germany | 300928, 309050,309110, 300296 | syringes |
BD Micolance 3 (20G yellow) Cannula | Becton Dickinson GmbH, Heidelberg, Germany | 305888 | venous catheter |
BD Venflon Pro Safety (20G pink) | Becton Dickinson GmbH, Heidelberg, Germany | 4491101 | venous catheter |
Buprenorphine (Buprenovet) | Bayer Vital AG, Leverkusen, Germany | 794-996 | analgesia |
Cefuroxime 750mg, powder for preparing injection solution | FRESENIUS KABI Deutschland GmbH, Bad Homburg, Germany | J01DC02 | antibiotics |
Covidien Hi-Contour, Endotracheal Tube 7,5 with Cuffed Murphy Eye | Covidien Deutschland GmbH,Neustadt/Donau, Germany | COV-107-75E | endotracheal Tube |
FENTANYL 0,5 mg Rotexmedica solution for injection Rotexmedica GmbH | Arzneimittelwerk, Trittau, Germany | 4993593 | opioide analgetic agent |
Furosemide-ratiopharm 250 mg/25 ml solution for injection | Ratiopharm GmbH, Ulm, Germany | 1479542 | loop diuretics |
Glucose 5% solution for infusion (500ml, 250ml) | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 3705273, 03705422 | infusion fluid |
Glucose 20% solution for infusion | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 4164483 | osmotic diuresis |
Heparin-Sodium 5000 I.E./ml | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 15782698 | anticoagulant |
Isoflurane-Piramal (Isoflurane) | Piramal Critical Care Deutschland GmbH, Hallbergmoos, Germany | 9714675 | volatile anaesthetic agent |
Ketamine (Ketamine hydrochloride) 10% | Medistar Arzneimittelvertrieb GmbH, Ascheberg, Germany | 4230 | general anaestetic agent |
MIDAZOLAM 15mg/3ml | Rotexmedica GmbH, Arzneimittelwerk, Trittau, Germany | 828093 | hypnotica, sedative agent |
NaCl 0,9% solution for infusion (500ml,1000ml) | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 864671.8779 | infusion fluid |
Norepinephrine (Arterenol) | Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany | 16180 | increase in blood pressure |
Pantoprazole 40mg/solution for injection | Laboratorios Normon,Madrid, Spain | 11068 | proton pump inhibitor |
Paveron N 25mg/ml solution for injection (Papaverine Hydrochloride) | LINDEN Arzneimittel-Vertrieb-GmbH, Heuchelheim, Germany | 2748990 | spasmolytic agent for vasodilatation |
Propofol 1% (10mg/ml) MCT Fresenius | FRESENIUS KABI Deutschland, GmbH, Bad Homburg, Germany | 654210 | general anaesthetic agent |
Ringer solution | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 1471411 | infusion fluid |
Urine catheter ruffle 12CH | Wirutec Rüsch Medical Vertriebs GmbH, Sulzbach, Germany | RÜSCH-180605-12 | transurethral urine catheter |
Surgical materials | |||
Appose ULC Skin Stapler | Covidien Deutschland GmbH,Neustadt/Donau, Germany | 8886803712 | skin stapler |
Feather Disposable Scapel (11)(21) | Feather, Japan | 8902305.395 | scapel |
Prolene 2-0, blue monofil VISIBLACK, FS needle | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | EH7038H | skin |
Prolene 5-0 (simply angulated, C1 needle) blue monofil VISI-BLACK | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | EH7227H | vascular |
Prolene 5-0 (double armed, C1 needle) 60cm | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | KBB5661H | vascular |
Prolene 6-0 (double armed, C1 needle) 60cm | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | EH7228H | vascular |
Sempermed derma PF Surgical Gloves Seril Gr. 7, 7.5, 8 | Semperit investment Asia Pte Ltd, Singapore | 4200782, 4200871, 4200894 | surgical gloves |
Sentinex® PRO Surgical Gowns Spunlace XL 150cm | Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany | 19302 | surgical gown |
Telasorp Belly wipes (green 45x45cm) | PAUL HARTMANN AG, Heidenheim, Germany | 4542437 | abdominal towel |
Pediatric urine catheter | Uromed Kurt Drews KG, Oststeinbeck, Germany | PZN 03280856 | used for the uretero-cutaneus stoma |
VICRYL- 0 MH Plus | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | V324 | fascial closure |
VICRYL – 3-0, SH1 Plus needle, 75cm | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | W9114 | subcutaneous suture, peritoneal suture |
VICRYL – 3-0, SH1 Plus needle, 75cm | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | V780 | subcutaneous suture, peritoneal suture |
VICRYL – ligatures Sutupak purple braided, 3-0 | Johnson & Johnson Medical GmbH- Ethicon Deutschland, Norderstedt, Germany | V1215E | threads for ligature |
3M™ Standard Surgical Mask 1810F | 3M Deutschland GmbH, Neuss, Germany | 3M-ID 7000039767 | surgical mask |
Surgical instruments | |||
Anatomical forceps Standard | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | PZ0260 | anatomical forceps |
Atraumatic tweezers steel, De Bakey Tip 1,5mm 8" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF0840 | anatomical atraumatic forceps |
Bipolar forceps 16 cm straight, Branch 0,30 mm pointed, universal fit | Bühler Instrumente Medizintechnik GmbH,Tuttlingen, Germany | 08/0016-A | biopolar forceps |
Bulldog clamp atraumatic, curved, De bakey 78 mm, 3" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF0900 | bulldog clamps |
DE BAKEY-SATINSKY vascular clamp 215mm | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF1661 | vascular clamp |
Dissecting scissors Mayo, 250 mm, 10" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC2232 | Scissors for dissection |
Dissecting scissors Metzenbaum-Fino, 260 mm, 101/4" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC2290 | Scissors for dissection |
Draeger CATO Anesthetic machine with PM8050 Monitor | Dräger, Drägerwerk AG & Co. KGaA, Lübeck, Germany | 106782 | Ventilation System |
Fine Tweezers, ADSON 180 mm | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | ADSONPZ0571 | fine forceps |
Gosset abdomenal wall spreader | CHIRU-INSTRUMENTE, Kaierstuhl, Germany | 09-621512 | abdominal retractor |
Microsurgical/watermaker tweezers LINZ 150mm 6" Ergo round handle | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | MN0087 | fine microsurgical forceps |
Surgical forceps Standard 5 3/4" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | PZ1260 | surgical forceps |
Surgical scissors standard pointed-blunt (thread/cloth scissors)175 mm, 7" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC1522 | surgical scissors |
Further material | |||
Heating pad | Eickemeyer – Medizintechnik für Tierärzte KG, Tuttlingen, Germany | 648050 MHP-E1220 | maintain body temperature during surgery |
Laryngoscope, customized | Wittex GmbH, Simbach, Germany | 333222230 | expose the vocal cord |
Rectal temperature probe | Asmuth Medizintechnik, Minden, Germany | ASD-RA4 | measure body temperature |
Ultrasound device, Sonosite Edge-II | FUJIFILM SonoSite GmbH, Frankfurt, Germany | V21822 | ultrasound and color Doppler |
Urine bag 2000ml Volume | ASID BONZ GmbH, Herrenberg, Germany | 2062578 | disposable urine bag connected to the uretero-cutaneous fistula catheter |