Which Incision is Better for Orthotopic Rat Liver Transplantation, Transverse or Midline?

Orthotopic rat liver transplantation (OLT) is a complex procedure extensively applicable to basic science, myriad complications can occur, incision-related self-biting has not been reported after liver transplantation. For the project of tolerance induction through stem cells, OLT was performed from inbred Sprague Dawley (SD) rat to SD (control group, n = 9), SD to Lewis (chronic rejection, n = 11), and OLT from Lewis allograft to Brown Norway (BN) rats (acute rejection, n = 63), the acute rejection group was sub-grouped into the transverse incision group(n = 26) and midline group(n = 37), Cyclosporine A was injected at 2mg/kg into the rejection groups once daily for 14 days, lidocaine cream alone or with naloxone was used for pain-relieving. The recipient survival and wound status were the primary endpoint of this study. For SD→SD, 30-day survival rate was 88.9%, no self-biting behavior occurred; for SD→Lewis, 30-day survival rate was 54.5%, the degree II of self-biting occurred in 2 cases. For Lewis→BN with transverse incision, 30-day survival rate was 51.8%, severe self-biting occurred in 16 cases in 8–27 days and 5 more cases over 30 days, which caused death or euthanasia, the degree 2 of biting occurred in 2 cases. For Lewis→BN with midline incision, 30-day survival rate was 86.0%, no severe self-biting occurred, mild self-biting in 2 cases. There was difference in the biting–related survival between two sub-groups (p = 0.003). In conclusion, incision-related self-biting behavior is species-specific for rats, the transverse incision is the pain-causing reason; the midline one is effective to avert occurrences.