Anatomic and radiologic bases of combined transplantation of liver and small intestine in the pig.

In order to assess the tolerance induced by hepatic transplantation in a multivisceral graft, a model of a transplant combining the liver and small intestine was developed in the pig, using animals of Large White Isogroup O, typed in the system of major incompatibility as “Swine lymphocyte antigen” (SLA), whose weight varied from 30 to 40 kg. In order to limit the duration of warm ischemia, dissection of the graft was performed on the donor animal with respect for the following anatomic features: -absence of intestinal attachment to the posterior parietal peritoneum, -anti-clockwise torsion of 360° of the intestine around the superior mesenteric a. with the small intestine convolutions on the right and the colonic helix on the left. The bifid pancreas follows this rotation and its resection must respect the vascularisation of the proximal small intestine; -the hepatic a. arises from a common trunk with a gastrosplenic branch of the aorta between the crura of the diaphragm and travels sagittally from behind foward toward the liver pedicle, which it reaches ar the upper border of the duodenum; -the hepatic a. and its branches are dorsal in relation to the portal vein; -the hepatic arterial distribution follows a right-left and antero-posterior systematisation for the six hepatic lobes of this quadruped animal.