title: Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol.
abstract: Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease. It offers better life expectancy and higher quality of life when compared to dialysis. Although the last few decades have seen major improvements in patient outcomes following kidney transplantation, the increasing shortage of available organs represents a severe problem worldwide. To expand the donor pool, marginal kidney grafts recovered from extended criteria donors (ECD) or donated after circulatory death (DCD) are now accepted for transplantation. To further improve the postoperative outcome of these marginal grafts, research must focus on new therapeutic approaches such as alternative preservation techniques, immunomodulation, gene transfer, and stem cell administration. Experimental studies in animal models are the final step before newly developed techniques can be translated into clinical practice. Porcine kidney transplantation is an excellent model of human transplantation and allows investigation of novel approaches. The major advantage of the porcine model is its anatomical and physiological similarity to the human body, which facilitates the rapid translation of new findings to clinical trials. This article offers a surgical step-by-step protocol for an autotransplantation model and highlights key factors to ensure experimental success. Adequate pre- and postoperative housing, attentive anesthesia, and consistent surgical techniques result in favorable postoperative outcomes. Resection of the contralateral native kidney provides the opportunity to assess post-transplant graft function. The placement of venous and urinary catheters and the use of metabolic cages allow further detailed evaluation. For long-term follow-up studies and investigation of alternative graft preservation techniques, autotransplantation models are superior to allotransplantation models, as they avoid the confounding bias posed by rejection and immunosuppressive medication.
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital; Division of Nephrology, The Hospital for Sick Children; moritz.kaths@gmail.com.
authors.forename: J Moritz
authors.initials: JM
authors.lastname: Kaths
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital; Programa de Doctorat en Medicina, La Universitat Autónoma de Barcelona.
authors.forename: Juan
authors.initials: J
authors.lastname: Echeverri
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Goldaracena
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
authors.forename: Kristine S
authors.initials: KS
authors.lastname: Louis
authors.affiliation: Laboratory Medicine and Pathobiology, Toronto General Hospital.
authors.forename: Paul
authors.initials: P
authors.lastname: Yip
authors.affiliation: Laboratory Medicine and Pathobiology, Toronto General Hospital.
authors.forename: Rohan
authors.initials: R
authors.lastname: John
authors.affiliation: Department of Medicine, Toronto General Hospital.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
authors.affiliation: Departments of Surgery (Urology) & Physiology, Developmental & Stem Cell Biology, The Hospital for Sick Children.
authors.forename: Darius
authors.initials: D
authors.lastname: Bagli
authors.affiliation: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital.
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.affiliation: Division of Nephrology, The Hospital for Sick Children.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Robinson
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D013552:Swine; D014019:Tissue Donors; D014182:Transplantation, Autologous