Human small bowel storage: the role for luminal preservation solutions.
BACKGROUND
Graft injury incurred during periods of cold storage remains a factor affecting the success of small bowel (SB) transplantation. No one preservation solution, including the gold standard University of Wisconsin (UW) solution, has been able to maintain graft integrity for storage periods paralleling that of other commonly transplanted intra-abdominal organs. We investigated the role for the luminal administration of preservation solutions in a small animal model, documenting significantly improved graft quality. The current study addresses direct clinical applicability using human SB.


METHODS
Human SB was obtained at the time of standard multiviscera procurement. After a common intra-arterial UW flush, the SB was immediately removed from the abdomen, randomly divided into three segments, and treated as follows (n=6-9): group 1, no luminal flush; group 2, luminal flush with UW solution; and group 3, luminal flush with an amino acid- enriched solution. Analysis of cellular energetics, permeability, and histologic injury was performed throughout 24 hr of cold storage.


RESULTS
Mucosal barrier function, measured by mannitol permeability, was significantly better overall in groups 2 and 3, with 24-hr values measuring 31 and 34 nmol/cm2/hr versus 57 nmol/cm2/hr, respectively (both P<0.05). Significantly less morphologic injury was also noted in the luminally treated specimens (groups 2 and 3) compared with the clinical standard (vascular flush with UW solution). Damage in group 1 reached gross villus denudation with an obvious elevated risk of villus tissue loss, whereas groups 2 and 3 only exhibited epithelial clefting to varying degrees.


CONCLUSIONS
This study supports luminal administration of preservation solutions for improvement of human SB graft quality during clinically relevant periods of cold storage.
Olson
David W
DW
Surgical-Medical Research Institute, University of Alberta, Edmonton, Alberta, Canada.
Jijon
Humberto
H
Madsen
Karen L
KL
Al-Saghier
Mohammed
M
Zeng
Janice
J
Jewell
Laurence D
LD
Bigam
David L
DL
Churchill
Thomas A
TA
D000241:Adenosine / Q000494:pharmacology; D000255:Adenosine Triphosphate / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000493:Allopurinol / Q000494:pharmacology; D004734:Energy Metabolism; D005978:Glutathione / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D007413:Intestinal Mucosa / Q000378:metabolism; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011887:Raffinose / Q000494:pharmacology
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose