**3. Conclusion**

538 A Bird's-Eye View of Veterinary Medicine

Donor animals were anesthetized by intravenous injection of 3% pentobarbital sodium dissolved in normal saline (0.5 mL/kg). Under sterile conditions, a large, crucial incision was made in the abdominal wall and the liver was harvested. One cannula was placed in the portal vein and another was placed in the inferior vena cava below the liver. The splenic and renal veins were ligated. The liver was perfused with HTK solution at 4 °C, and bleeding

Recipient animals were anesthetized by intravenous injection of 3% pentobarbital sodium dissolved in normal saline (0.5 mL/kg), followed by subcutaneous injection of atropine (0.03–0.04 mg/kg). Recipient surgery was undertaken while the donor liver was undergoing Histidine- Tryptophan- Ketoglutarate (HTK) perfusion. Briefly, a large, cross-shaped incision was made in the abdominal wall. The perihepatic ligaments and inferior vena cava above and below the liver were separated from adjacent structures. The hepatic artery, portal vein and biliary tract were separated at the porta hepatis. Tissues surrounding the inferior vena cava below the liver between the right renal and right adrenal veins were separated over 0.5–1.0 cm. The right suprarenal and lumbar veins were ligated adjacent to the inferior vena cava using a 4-0 suture. Blood was collected from the liver according to the autotransfusion method described for rat liver transplantation. The inferior vena cava below the liver and the portal vein were clamped, and 60–100 mL of sterile balanced salt solution was slowly injected into the portal vein until the liver became khaki in color. The inferior vena cava above the liver was then immediately clamped. The inferior vena cava above the liver was cut adjacent to the liver, and was trimmed into a bellmouth shape at the bifurcation of the portal vein. The inferior vena cava was cut below the liver with some liver tissue included. The donor liver was transplanted using standard orthotopic liver transplantation techniques (double-cuff and one support tube). The inferior vena cava above the liver was anastomosed using 5-0 prolene, the cuff of the portal vein was anastomosed and the portal vein was declamped. When blood was observed flowing from the inferior vena cava below the liver, the cuff was anastomosed. The inferior vena cava above and below the liver were declamped to terminate the anhepatic phase. The liver and gastrointestinal tract were perfused with 0.9% sodium chloride injection at 40–50 °C for rewarming until the color of the liver was restored. The common hepatic artery was anastomosed and a supporting tube was placed in the common bile duct. The abdominal cavity was washed with warm saline. If no hemorrhage or bile leakage was detected, the

Animal activities, facial expressions, food and water intake and reactions to stimulation were observed. Animals who died were immediately dissected to obtain samples and to analyze the cause of death. Each monkey was caged separately at 22–25 °C and was allowed access to water after 24 hours and food after 48 hours. Intramuscular cefazolin sodium (0.1 g/kg) was administered twice a day for 2 days. Colloid and sugar water (500–1 000 mL per day) was administered postoperatively to maintain electrolyte and acid-base balance.

tissues were ligated. A 2 mm diameter supporting tube was placed in the bile duct.

**2.3 Donor surgery and liver perfusion** 

**2.4 Recipient surgery** 

abdominal wall was closed.

**2.5 Postoperative observation and treatment** 

We successfully performed liver transplantation in 25 pairs of rhesus monkeys. In the early postoperative period (within 6 hours after portal vein opening), seven animals (25%) died; five (20%) due to abdominal hemorrhage, one (4%) due to primary nonfunction and 1 (4%) due to pneumothorax-induced respiratory failure. In the short-term postoperative period (12–72 hours after portal vein opening), seven animals (28%) died; one due to hyperacute rejection within 12 hours, one due to hyperacute rejection and arterial thrombosis within 12 hours, one due to pulmonary infection and one due to accidental death at 72 hours. In the long-term postoperative period (> 72 hours after portal vein opening), eleven animals (44%) died; six due to acute rejection, three due to arterial thrombosis and two due to pulmonary infection. Abdominal hemorrhage occurred mainly in the early and short-term postoperative periods, and acute rejection occurred mainly in the long-term postoperative period.
