TABLE 1. Troubleshooting table
Step
1-8
Problem
Mortality
Possible cause
Starting animal
weight was lower
than 100g
Confirm that all your
animals are
between 100-140g
when retrorsine
treatment starts
Intraperitoneal
injections caused a
perforation or
internal bleeding
Check the
intraperitoneal
injection technique
and ask for
adequate training to
the veterinary
personnel of your
institution
Apply pressure
using cotton swabs
for 1-2 minutes. If
the bleeding does
not stop, use the
cautery device to
stop the bleeding
The knot needs to
be tightened
The graft should not
be used for
transplantation.
The knot needs to
be position away
more than 2mm
from the
suprahepatic vena
cava.
Apply pressure
using cotton swabs
for 1-2 minutes. If
the bleeding does
not stop, add
additional stitches to
anastomosis
Apply pressure
using cotton swabs
for 1-2 minutes
10-17
Bleeding
Incision cut
capillaries
26-28
Bleeding from the
stumps
Poor outflow of the
resected graft
Loose knot
37-49
Bleeding from
anastomosis sites
End-side
anastomosis is not
entirely close
37-49
Excessive bleeding
from the surface of
the liver graft
37-49
Intestinal
congestion
The graft was
damaged during
surgical
manipulation
Portal vein end-side
anastomosis is
obstructed due to
tighten suture or
28
Solution
Knot is placed too
close to the
suprahepatic vena
cava causing vena
cava stenosis
Gently massage the
anastomosis site in
a circular motion
using cotton swabs.
blood clot
Re-anastomosis is
sometimes useful
as alternative
solution. However,
Re-clamp of portal
flow after
reperfusion to the
graft might cause
blood clotting inside
the graft.
Gently massage the
anastomosis site in
a circular motion
using cotton swabs.
Additionally, gently
move the graft from
it position to a more
anatomical position
that allows blood
flow
Make sure the
ligation is tighten
37-49
Congestion of the
transplanted graft
Infrahepatic IVC
end-side
anastomosis is
obstructed due to
tighten suture or
blood clot or twisted
Infrahepatic IVC
37-49
Low perfusion
pressure of the
transplanted graft
Ligation of native
portal vein is loosen
50
Duodenum wall
bleeding
Low blood pressure
due to excessive
depth of anesthesia
Aggressive surgical
manipulation
54
Not eating solid
food
Intestinal
obstruction
55
Rapid weight loss
Dose of
immunosuppressant
Lower the
anesthesia
temporarily
Apply pressure
using cotton swabs
for 1-2 minutes. If
the bleeding does
not stop, add an
additional stitch to
the bleeding site
Bile duct
reconnection can
cause intestinal
stenosis. Provide
liquid diet for a few
days. If the animal
does not drink liquid
diet, the animal
should be
euthanized
Observing weight
loss in the first postoperative week is
normal. If weight
loss continues after
the first week,
reduce the dose of
immunosuppressant
around
0.7mg/kg/day and
administer at the
same time of the
day
Bile duct obstruction
If the animal shows
signs of distress
and continuous
weight loss after the
second week, the
animal should be
euthanized