Liver transplantation using magnetic anastomosis in pigs

Abstract Magnetic anastomosis substantially shortens the duration of vascular anastomosis. We aimed to apply magnetic anastomosis technology (MAT) to donor liver implantations in pig orthotopic liver transplantation (OLT). Twenty healthy adult pigs were randomly divided into donors and recipients, and major vascular anastomosis was performed using MAT during OLT. Recipient liver and kidney function was measured pre-surgery and 12, 24 and 72 h post-surgery. Vascular anastomoses examinations were performed using ultrasound or angiography weekly post-surgery, and pathological examinations of vascular anastomoses were performed during autopsy after animal euthanasia. All recipients survived 24 h after surgery, which is considered as successful transplantation. Anhepatic duration was only 13 min, and no anastomotic obstruction or stenosis, magnetic displacement and anastomotic angulation, or distortion was found upon postoperative examinations of major liver vasculature. Aspartate aminotransferase, alanine aminotransferase, and total bilirubin serum levels increased considerably postoperatively. The follow-up period for this study was 1 year, and the median survival time of all recipients was 115 d (interquartile range = 11–180 d). The main causes of death were liver failure, immune rejection, infection, and arterial anastomotic bleeding. Moreover, vascular anastomoses healed well with a survival time of more than two weeks. We developed a novel magnetic device to create a fast and safe technique to perform major vascular anastomoses in pig liver transplantations. Additionally, the liver graft implantation using MAT considerably shortened the recipient warm ischemia time, which will reduce the extent of ischemia–reperfusion injury. We conclude that MAT is an effective method for donor liver fast implantation in OLT in pigs.