Biomedical Engineering Reference
In-Depth Information
TABLE 16.3
Recipient Protocol for Orthotopic Pig Liver Transplantation in Baboons
Day
Procedure/Therapy
e27
Jacket training
e20
Tether training
e14
Mixed lymphocyte reaction (MLR) versus WT, GTKO, and GTKO/CD46 pig PBMC. (Same pigs have to be used
as sources of PBMC after liver Tx)
Store serum and plasma for complement-dependent cytotoxicity assay (CDC), antibody binding assays (by FACS),
and coagulation studies
T and B cell count
e6
Intravascular catheter insertions (Two venous [IJV and EJV] and one arterial [carotid artery])
Blood samples for CBC, PT, aPTT, ACT, INR, fibrinogen, LFTs,
RFTs, electrolytes, total protein, albumin, cholesterol, triglyceride, amylase, lipase, iron, CH50
Buprenorphine 0.01 mg/kg i.v. or ketoprofen 2 mg/kg i.v. x 2 daily for 3 days
Cefazolin 25 mg/kg i.v. x 2 daily for 2 days
Begin famotidine 0.25 mg/kg i.v. x 2/day and continue daily
Begin mycophenolate mofetil (MMF) 110 mg/kg by continuous i.v. infusion to maintain blood level of
3e6
m
g/ml
e5
Begin tacrolimus 0.05e0.2 mg/kg x 2 daily i.m. to maintain a blood trough level of 10e20 ng/ml
e4
MMF and tacrolimus levels every day until the day of Tx
T and B cell count
e3
Begin ganciclovir prophylaxis 5 mg/kg/day i.v., and continue daily
Blood culture
Antithymocyte globulin (ATG) 2e10 mg/kg i.v., depending on the WBC count (to reduce the CD3
þ
T cell
count to
500 cells/mm
3
)
<
e2
e1
CBC
lymphocyte subset counts
Antithymocyte globulin (ATG) 2e10 mg/kg i.v., depending on the WBC count (to reduce the CD3
þ
T cell
count to
þ
500 cells/mm
3
)
Cobra venom factor 1e3 mg i.v. daily for 4 days (to maintain the CH50
<
10%)
<
NPO after noon e fluids only for 18 hours before surgery
Check infusion pumps and cassettes (see A below)
Ketorolac 0.5 mg/kg i.v. daily (half-life 3.5e9 hours)
0
Hold morning tacrolimus and MMF before surgery
CH50 daily (give CVF if indicated)
Begin methylprednisolone i.v. x 2 daily as per protocol (see B below)
Prostaglandin I
2
by continuous i.v. infusion for 3e5days
Cefazolin 25 mg/kg i.v. x 2 daily for 3 days
Imipenem 500 mg i.v. x 3 daily (depending on baboon weight) for 3 days
Amikacin 150 mg i.v. daily for 3 days
Heparin 100 U/kg i.v.
Recipient hepatectomy
splenectomy
Orthotopic liver transplantation
Liver biopsy before abdominal closure (formalin, OCT, EM)
Blood samples for CBC; LFTs, PT, aPTT, INR, fibrinogen
Buprenorphine 0.01 mg/kg i.v. 2x daily for 3 days or ketoprofen
Hold afternoon tacrolimus dose after Tx
Begin continuous i.v. heparin infusion
Blood pressure monitoring through arterial line
þ
1
Hold morning tacrolimus dose (until level known)
Blood samples for CBC, PT, aPTT, ACT, INR, fibrinogen, chemistry, electrolytes
Vitamin K (5 mg i.v. daily)
Blood sample for tacrolimus level daily
Blood sample for MMF level alternate days
Adjust ACT to 160 s by increasing rate of heparin infusion
Blood culture (on alternate days)
Store serum and plasma samples daily for coagulation studies, Western blot, antibody binding assays, etc.
