A novel technique of hypothermic luminal perfusion for small bowel preservation.
BACKGROUND
This study improved small bowel preservation using University of Wisconsin (UW) solution in conjunction with hypothermic luminal perfusion.


METHODS
Small bowels from Sprague-Dawley rats (n=4) were flushed vascularly with modified UW solution and flushed luminally: group 1, none (clinical control); group 2, UW solution; group 3, 1-hr oxygenated perfusion then static storage with UW; and group 4, 24-hr continuous oxygenated perfusion with UW. Energetics, lipid peroxidation, and histology were assessed during 24 hr at 4 degrees C.


RESULTS
After 12 hr, adenosine triphosphate ranged from 0.5 to 0.8 micromol/g in groups 1 to 3 compared with 1.5 micromol/g in group 4. Even after 24 hr, levels in group 4 were more than twofold greater than levels in groups 1 to 3. Energy charge values ([adenosine triphosphate+adenosine diphosphate/2]/total adenylates) decreased from fresh tissue values of 0.69 in all groups except group 4 throughout 24-hr perfusion. Malondialdehyde (MDA; a product of lipid peroxidation) doubled within 4 hr in group 1 and remained high throughout storage. In groups 3 and 4, MDA levels increased as the time of perfusion increased; group 2 showed no elevated MDA levels at any time. After 12 hr, histologic integrity was superior in groups 3 and 4; however after 24 hr, the best Park's grade was observed in group 3 (median grade 4) compared with groups 1 (grade 7) and 4 (grade 6).


CONCLUSIONS
Our data indicate that perfusion clearly improves tissue energetics; however, mucosal integrity is superior with only a brief 1-hr period of luminal perfusion, despite limited improvements in energetics.
Zhu
Jay Z J
JZ
Surgical-Medical Institute, University of Alberta, Edmonton, Canada.
Castillo
Erika G
EG
Salehi
Payam
P
Avila
Jose
J
Lakey
Jonathan R T
JR
Churchill
Thomas A
TA
D000227:Adenine Nucleotides / Q000378:metabolism; D000241:Adenosine; D000244:Adenosine Diphosphate / Q000378:metabolism; D000255:Adenosine Triphosphate / Q000378:metabolism*; D000493:Allopurinol; D000818:Animals; D004734:Energy Metabolism / Q000502:physiology; D005978:Glutathione; D007328:Insulin; D007421:Intestine, Small / Q000378:metabolism / Q000637:transplantation*; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods*; D011887:Raffinose; D051381:Rats; D017207:Rats, Sprague-Dawley; D014184:Transplantation, Homologous / Q000502:physiology*
D000227:Adenine Nucleotides; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008315:Malondialdehyde; D000244:Adenosine Diphosphate; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose