title: Multivisceral transplantation in pigs: a model for research and training.
abstract: OBJECTIVE
  To present a model for research and training in multivisceral transplantation in pigs.
  
  
  METHODS
  Eight Large White pigs (four donors and four recipients) were operated. The multivisceral transplant with stomach, duodenum, pancreas, liver and intestine was performed similarly to transplantation in humans with a few differences, described below. Anastomoses were performed as follows: end-to-end from the supra-hepatic vena cava of the graft to the recipient juxta diaphragmatic vena cava; end-to-end from the infra-hepatic vena cava of the graft to the inferior (suprarenal) vena cava of the recipient; and end-to-side patch of the aorta of the graft to the infrarenal aorta of the recipient plus digestive reconstruction.
  
  
  RESULTS
  The performance of the multivisceral transplantion was possible in all four animals. Reperfusions of the multivisceral graft led to a severe ischemia-reperfusion syndrome, despite flushing of the graft. The animals presented with hypotension and the need for high doses of vasoactive drugs, and all of them were sacrificed after discontinuing these drugs.
  
  
  CONCLUSIONS
  Some alternatives to minimize the ischemia-reperfusion syndrome, such as the use of another vasoactive drug, use of a third pig merely for blood transfusion, presence of an anesthesia team in the operating room, and reduction of the graft, will be the next steps to enable experimental studies.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Department of Transplants, Universidade de São Paulo - USP, Sao Paulo, SP, BR.
authors.forename: André Ibrahim
authors.initials: AI
authors.lastname: David
authors.affiliation: Centro de Experimentação e Treinamento (CETEC), Instituto Israelita de Ensino e Pesquisa Albert Einstein - IIEPAE, Sao Paulo, SP, BR.
authors.forename: Valéria Vieira
authors.initials: VV
authors.lastname: Chida
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Department of Transplants, Universidade de São Paulo - USP, Sao Paulo, SP, BR.
authors.forename: Andre Dong Won
authors.initials: AD
authors.lastname: Lee
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Sao Paulo, SP, BR.
authors.forename: Felipe Soares Oliveira Rodrigues
authors.initials: FS
authors.lastname: Fiuza
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Sao Paulo, SP, BR.
authors.forename: Daniela Medeiros
authors.initials: DM
authors.lastname: Calil
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Sao Paulo, SP, BR.
authors.forename: Danielle de Carvalho
authors.initials: Dde C
authors.lastname: Mantovani
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Sao Paulo, SP, BR.
authors.forename: Eduardo Rullo
authors.initials: ER
authors.lastname: Maranhão
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, Sao Paulo, SP, BR.
authors.forename: Gabriel Beligni
authors.initials: GB
authors.lastname: Campi
authors.affiliation: Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Botucatu, SP, BR.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Llanos
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP, BR.
authors.forename: Ben-Hur
authors.initials: BH
authors.lastname: Ferraz Neto