This protocol provides technical information for vessel reconstruction using the cuff technique in mouse orthotopic liver transplantation.
Mouse orthotopic liver transplantation is an effective methodology for investigating the underlying mechanisms of liver ischemia and reperfusion injury. However, the technical challenges pose a barrier to utilizing this valuable experimental model and passing on these skills to the next generation. The most challenging aspect of this procedure is vascular reconstruction, including the portal vein (PV), infrahepatic inferior vena cava (IHIVC), and suprahepatic inferior vena cava. The use of plastic cuffs, rather than sutures, allows for smoother PV and IHIVC reconstruction. Vessels are reconstructed by attaching a cuff made from an intravenous catheter to the tip of the graft vessel and interposing the cuff into the recipient vessel. The two most crucial aspects are properly visualizing the inner lumen of the vessel and avoiding the use of excessive force. Our aim is to provide a technical overview of vascular reconstructions using the cuff technique in recipient surgery. These technical tips for the cuff technique are expected to help microsurgeons facilitate vascular reconstruction and advance their research.
Mouse orthotopic liver transplantation (MOLT) is an effective experimental method first reported in 19911. This experimental model, which utilizes genetically modified mice and various research reagents, has played a pivotal role in investigating warm and cold ischemia and reperfusion injuries. However, the model's high technical complexity has hindered the development of basic medicine for liver transplantation2. MOLT involves three major steps: (1) retrieval of the liver from the donor mouse, (2) back table surgery, and (3) implantation of the liver into the recipient. Among these recipient procedures, vascular anastomosis poses the greatest challenge. While the suprahepatic inferior vena cava anastomosis is typically completed by hand stitching2, the infrahepatic inferior vena cava (IHIVC) and portal vein (PV) can be reconstructed more efficiently using plastic cuffs in place of hand-sewn sutures.
The anhepatic period signifies the interval between the removal of the recipient's native liver and the graft implantation. To ensure consistent results, it is imperative to limit the anhepatic time to less than 20 min. Consequently, studies employing this model have been confined to specific institutions3,4,5,6,7,8,9. Among the various stages of MOLT, achieving smooth PV and IHIVC reconstruction is crucial for minimizing anhepatic time and ensuring successful transplantation.
PV and IVC reconstruction is generally carried out using vascular cuffs since the cuff technique simplifies vascular anastomosis compared to hand-sewn sutures2,5,8. The technique involved in vascular cuff preparation and secure attachment of the cuff significantly impacts the complexity of recipient vascular reconstruction. Our objective is to provide detailed visual guidance for numerous technical tips related to the cuff method, thereby reducing the learning curve. These video clips will provide a clear understanding of how to attach the cuff to the vessels and reconstruct the PV and IHIVC during recipient surgery.
Learning vascular reconstruction is the most challenging aspect of achieving successful MOLT. The cuff’s quality significantly influences the reconstruction’s difficulty, given the small size of mice5. This article provides a detailed protocol for cuff preparation, attachment, and reconstruction.
While there are no major differences from previous reports regarding cuff preparation and connection2,5, some minor p…
The authors have nothing to disclose.
This work was supported by 2022 JST basic research (The Japanese Society for Transplantation).
16 G intravenous catheter | TERUMO | SR-FF2032 | IHIVC cuff |
20 G intravenous catheter | TERUMO | SR-FF1651 | PV cuff |
8-0 braid silk | Natsume Seisakusho | CR9-80B2 | 8-0 silk |
Belzer UW Cold Storage Solution | Astellas | Organ preservation fluid | |
Bulldog clamp | B BRAUN | FB329R | Bulldog clamp |
C57BL/6 mice | Oriental Bio Service | ||
Isoflurane inhalation solution | Viatris | Anesthesic | |
Micro Blunted Tips 0.1 mm x 0.06 mm | F.S.T | 11253-20 | Straight microforceps |
Micro Serrefine Clamp Applicator with Lock | F.S.T | 18056-14 | Vessel clip applicator |
Micro Serrefines | F.S.T | 18055-4 | Vessel clip |
No.11 Spare Blades | FEATHER Safety Razor | 11 | Blades |
Ophthalmic scissor, round handle | B BRAUN | FD103R | Microscissor |
Plastic rectangular-shaped container | Daiso | 10 cm long, 15 cm wide and 6 cm high | |
SuperGrip Tips | F.S.T | 00649-11 | Curved microforceps |
SZX7 | Olympus | SZX7 | Microscope |