Nutrient-related issues affecting successful experimental orthotopic small bowel transplantation.
BACKGROUND
This study tested the effectiveness of a nutrient-rich preservation solution in a small animal model of orthotopic whole small bowel transplantation.


METHODS
Lewis rats received syngeneic total orthotopic small bowel graft after cold storage for 6 h. Donor small bowel was flushed vascularly with University of Wisconsin (UW) solution and flushed luminally with UW solution or an amino acid-rich (AA) solution as follows: Group 1, no luminal flush; Group 2, UW solution; Group 3, AA solution. Biopsies were taken over 14 days posttransplant; energetics, oxidative stress, neutrophil recruitment and histologic injury were assessed.


RESULTS
All animals in Groups 1 and 2 failed to survive 12 h posttransplant due to hemorrhagic shock and fluid loss. In contrast, all animals in Group 3 survived the operation; survival after 14 days was 80% (4/5). In Group 3, full recovery of tissue adenylates (ATP and energy charge) to freshly isolated tissue values occurred within 3 days. Oxidative stress as assessed by malondialdehyde (MDA) levels was low in Group 3 throughout 14 d; Groups 1 and 2 exhibited high oxidative stress over the initial 35 min reperfusion (P<0.05). Neutrophil recruitment (myeloperoxidase activity) was significantly reduced in Group 3 tissues, as was histologic injury (P<0.05 compared to Groups 1 and 2). By day 14, Group 3 exhibited complete mucosal restoration.


CONCLUSIONS
The data presented in this communication supports the use of an intraluminal preservation solution that is tailored to the metabolic requirements of the small bowel.
Salehi
Payam
P
Surgical-Medical Research Institute, University of Alberta, and Department of Laboratory Medicine and Pathology, Division of Anatomical Pathology, University of Alberta Hospital, Edmonton, Canada.
Zhu
Lin-Fu
LF
Sigurdson
Grant T
GT
Jewell
Lawrence D
LD
Churchill
Thomas A
TA
D000241:Adenosine / Q000494:pharmacology; D000255:Adenosine Triphosphate / Q000378:metabolism; D000493:Allopurinol / Q000494:pharmacology; D000596:Amino Acids / Q000008:administration & dosage*; D000818:Animals; D004734:Energy Metabolism; D005978:Glutathione / Q000494:pharmacology; D007328:Insulin / Q000494:pharmacology; D007413:Intestinal Mucosa / Q000503:physiopathology; D007421:Intestine, Small / Q000378:metabolism / Q000473:pathology / Q000637:transplantation*; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D020556:Neutrophil Infiltration; D019188:Organ Preservation Solutions / Q000737:chemistry* / Q000494:pharmacology*; D018384:Oxidative Stress; D009195:Peroxidase / Q000378:metabolism; D011184:Postoperative Period; D011887:Raffinose / Q000494:pharmacology; D051381:Rats; D011917:Rats, Inbred Lew; D012038:Regeneration; D016019:Survival Analysis
D000596:Amino Acids; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008315:Malondialdehyde; D000493:Allopurinol; D000255:Adenosine Triphosphate; D009195:Peroxidase; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose