A simpler rat kidney transplantation model: a variation
in arterial anastomotic technique
Received: 19 February 2013 / Accepted: 7 March 2013 / Published online: 19 April 2013
Springer-Verlag Berlin Heidelberg 2013
Background The rat kidney transplant (KTx) became a clas-
sic experimental model for training purposes in general
microsurgical techniques. We present a modified version
of the arterial ‘sleeve’ (telescoping) anastomotic technique.
Methods A cohort of rat kidney transplants executed with
this modified anastomotic technique was audited for execu-
tion times, long-term graft survival and complications.
Results The series comprises 70 KTx carried out by one
microsurgeon. The average warm ischaemic time was 25.75±
3.8 min, with an arterial anastomotic time of 10.82±3.85 min. It
decreased to less than 30 min (cut-off for long-term graft
damage) after nine transplants. The long-term survival rate
deaths were due to haemorrhage (1.42 %) and ureteric dehis-
cence (4.28 %).
Conclusions Telescoping the renal artery delivers good re-
sults with a faster, less laborious technique, making it a
useful addition to the experimental surgery laboratory. By
contrasting our results with reported series, we demonstrate
that the model can make the rat kidney transplant accessible
for a wider variety of scientists.
The rat kidney transplant (KTx) became a classic experimen-
tal model for training purposes in general microsurgical
techniques, as well as for transplantation-related experi-
mental studies ever since its introduction by Fisher and
Lee in 1961 . During the last five decades, variations
in surgical approach have been introduced, in an attempt
to generate a more predictable learning curve, reduce
the number of animals needed and find the most repro-
ducible, fastest and most durable technique for vascular
and ureter anastomosis .
The warm ischaemic time should be kept under 30 min, to
avoid morphological changes in the graft . Other important
factors which may cause ischaemia of the kidney and ureter
include inadequate ventilation during the operation, inadequate
systemic and local circulation after kidney reperfusion, occur-
rence of post-reperfusion syndrome and consequent hypoxia
. Injury due to inadequate handling of the periureteric tissue
can cause ureteral ischaemia, with consequent stricture forma-
tion and obstruction of the upper urinary tract .
Classically, the arterial anastomosis was done in an ‘end-
to-end’, ‘end-to-side’ or ‘sleeve’ technique. The sleeve tech-
nique was first described for humans by Murphy in 1897
and further developed for small vessels by Lauritzen and
Meier . The underlying concept was to telescope the
recipient artery inside the donor artery for a distance of 2–
3 mm, then secure the construct so there are no leaks once
blood flow is re-established. The basic design has many
variations, all having in common less manipulation, fewer
stitches, with a reliable, yet faster, microvascular anastomo-
sis than the end-to-end or end-to-side technique [7, 8].
We describe our experience with a modified version of
the arterial sleeve (telescoping) anastomotic technique in rat
kidney transplantation during a series of experiments on
transplant tolerance performed by the same microsurgeon.
The telescoping technique was used previously in our insti-
tution in multiple organ transplantation .
We detail the learning curve for this technique and the
variations to the classic method that we think make the
vascular part more accessible, and we present the long-
V. Ilie (*)
Department of Transplantation Surgery,
Royal Prince Alfred Hospital, Sydney, Australia
Collaborative Transplantation Group,
University of Sydney, Sydney, Australia
Eur J Plast Surg (2013) 36:341–344