A standardised and reproducible method for en bloc multi-visceral organ retrieval in a porcine model.

Abstract

Background: The rapidly changing landscape of abdominal transplantation including regional normothermic perfusion of abdominal organs during procurement, broadening indications for multi-visceral transplantation (MVT) in both benign and malignant pathology and the ever increasing gap between organ supply and demand have necessitated the normalisation of expanded criteria donors (ECD). Key to mitigating the increased risk of delayed or non-function of ECD organs is the development of suitable preclinical animal models that allow for the development of reliable viability assessment as well as reconditioning and repair protocols that can thereafter be translated to humans. Due to physiological and anatomical similarities to humans, pigs make ideal pre-clinical animal models. Our group has recently concluded a study assessing the feasibility of machine perfusion and reanimation in a porcine model. In this paper, the authors describe a reproducible en bloc surgical technique to retrieve a composite organ block containing the liver, pancreas, small bowel, and kidneys that can be used for preclinical translational studies on organ preservation, viability assessment and preconditioning with specific reference to pertinent porcine anatomy.

Methods: Twenty-six adult female Large White pigs (Sus scrofa domestica) were procured to obtain a multi-visceral organ block to evaluate the functionality of a novel machine perfusion rig. The average weight of the pigs was 63.05 kg. Each organ block was excised consistently by the same surgical team. The block was re-animated using ex vivo normothermic perfusion to simulate transplant and confirm viability.

Results: We describe the stepwise surgical technique of multi-organ retrieval as a combined organ block. The average procedure time was 108.3 (range, 57-179) min.

Conclusions: This surgical technique facilitated retrieval of all twenty-six organ blocks for experiments in MVT. The warm ischemia duration is minimal and closely replicates donation following brain death (DBD) in humans. With minor modifications, a donation following circulatory death (DCD) model would also be achievable. This technique is reproducible and safe and can be used to retrieve abdominal organs collectively for en bloc testing or to be divided subsequently on the back table, with each organ used for a distinct purpose or project.