Mechanism and impact of organ harvesting and ischemia-reperfusion injury within the graft muscularis in rat small bowel transplantation.
BACKGROUND
Inflammatory events within the gut muscularis contribute to dysmotility. We hypothesized that manipulation during organ harvesting initiated an inflammatory response via muscularis macrophages and that this cascade was amplified during reperfusion.


METHODS
Small bowel transplantation was performed in Lewis rats. To investigate the impact of organ harvesting on muscularis inflammation, cold whole-body perfusion was performed after versus prior to organ harvesting. The role of macrophages was investigated by transplantation of the macrophage-depleted gut. Leukocyte infiltration was investigated in muscularis whole mounts. Mediator mRNA expression was determined by real-time reverse transcriptase polymerase chain reaction. Contractility was assessed in a standard organ bath.


RESULTS
Organ harvesting and ischemia-reperfusion induced leukocyte recruitment and mRNA upregulation in the muscularis: interleukin-6 12217-fold, monocyte chemoattractant protein-1 62-fold, ICAM-1 12-fold, cyclooxygenase-2: 8-fold, iNOS: 150-fold. Although organ harvesting with cold ischemia prevented early gene expression, peak expression at 3-hour reperfusion was not changed by modification of the harvesting technique. Compared to controls, transplanted animals showed a 63% decrease in smooth muscle contractility. In contrast, transplanted macrophage-depleted gut exhibited significantly fewer leukocytes and only a 16% decrease in contractility.


CONCLUSIONS
Gut manipulation during organ harvesting initiates an inflammatory response within the muscularis that is massively intensified during reperfusion. This change contributes to muscular dysfunction. Furthermore, the results suggested that resident macrophages play a key role in initiating this process.
Schaefer
N
N
Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Strasse 25, Bonn D-53105, Germany.
Tahara
K
K
Schmidt
J
J
Zobel
S
S
Kalff
J C
JC
Hirner
A
A
Türler
A
A
D000818:Animals; D002469:Cell Separation / Q000379:methods; D007421:Intestine, Small / Q000502:physiology*; D008264:Macrophages / Q000166:cytology*; D023421:Models, Animal; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000502:physiology / Q000637:transplantation*; D051381:Rats; D011917:Rats, Inbred Lew; D015427:Reperfusion Injury; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014185:Transplantation, Isogeneic / Q000379:methods*