Research report of living donor kidney harvesting in Bama miniature pigs with six gene modified
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摘要:
目的 总结基因修饰猪活体供肾切取的经验及其实践价值。 方法 采用活体供肾切取技术，切取六基因修饰猪左侧肾脏。首先阻断输尿管，游离下腔静脉及腹主动脉后，切取过程中依次完成输尿管、肾静脉、肾动脉的显露、游离。在腹主动脉、下腔静脉上阻断钳，离断肾动脉、静脉后立即用4 ℃肾保存液进行灌注，保存在冰生理盐水中准备移植。同时完成供体腹主动脉、下腔静脉缺口的缝合。记录手术时间，出血量，热缺血和冷缺血时间，并发症发生情况以及供、受体存活情况。 结果 成功切取基因修饰猪左肾，取肾术中出血5 mL，热缺血时间45 s，冷缺血时间2.5 h。供、受体均未输血，植入受体内的肾脏恢复泌尿功能。切取左肾后供体健康存活8个月余。 结论 基因修饰猪活体供肾切取技术安全可靠，游离肾脏过程中同时处理分支血管，减少了修肾过程，缩短了冷缺血时间，活体供肾切取有助于后续供体存活并进行其他科学研究。 Abstract:Objective To summarize the experience and practical value of living donor kidney harvesting in Bama miniature pigs with six gene modified. Methods The left kidney of Bama miniature pigs with six gene modified was obtained by living donor kidney harvesting technique. First, the ureter was occluded, and then the inferior vena cava and abdominal aorta were freed. During the harvesting process, the ureter, renal vein and renal artery were exposed and freed in sequence. The vascular forceps were used at the abdominal aorta and inferior vena cava, and the renal artery and vein were immediately perfused with 4℃ renal preservation solution, and stored in ice normal saline for subsequent transplantation. Simultaneously, the donor abdominal aorta and inferior vena cava gap were sutured. The operation time, blood loss, warm and cold ischemia time, postoperative complications and the survival of donors and recipients were recorded. Results The left kidney of the genetically modified pig was successfully harvested. Intraoperative bleeding was 5 mL, warm ischemia time was 45 s, and cold ischemia time was 2.5 h. Neither donor nor recipient pig received blood transfusion, and urinary function of the kidney transplanted into the recipient was recovered. The donor survived for more than 8 months after the left kidney was resected. Conclusions Living donor kidney harvesting is safe and reliable in genetically modified pigs. Branch blood vessels could be processed during kidney harvesting, which shortens the process of kidney repair and the time of cold ischemia. Living donor kidney harvesting contributes to subsequent survival of donors and other scientific researches. -
图 1 活体供肾切取示意图
注：A图示预计切开的血管位置；B图示在血管根部离断肾静脉及动脉；C图示缝合下腔静脉、腹主动脉缺损。
Figure 1. Schematic diagram of living donor nephrectomy
图 2 活体供肾切取过程
注：A图示夹闭输尿管末端；B图示游离左肾静脉；C图示游离左肾动脉；D图示供肾动脉离断；E图示供肾静脉离断；F图示供肾灌注及修整。
Figure 2. The procedure of living donor nephrectomy
图 3 缝合腹主动脉及下腔静脉缺口
Figure 3. Suturing the notch of abdominal aorta and inferior vena cava
表 1 供体猪血常规检测
Table 1. Routine blood test of the donor pig
时间 红细胞
（×1012/L）白细胞
（×109/L）淋巴细胞
（×109/L）血红蛋白
（g/L）红细胞比容 平均红细胞
体积（/fL）平均红细胞血红
蛋白量（/pg）平均红细胞血红
蛋白浓度（g/L）术前 6.02 11.21 7.56 120 0.34 54.5 18.3 344 术后8个月 5.83 11.79 6.87 116 0.31 59.1 20.6 342 正常值 5.50~9.00 10.20~30.00 4.80~16.20 100~160 0.33~0.52 51.0~73.0 14.0~22.0 300~360 
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