Experimental small bowel transplantation from non-heart-beating donors: a large-animal study.
BACKGROUND
The shortage of organs in the last 20 years is stimulating the development of new strategies to expand the pool of donors. The harvesting of a graft from non-heart-beating donors (NHBDs) has been successfully proposed for kidney and liver transplantation. To our knowledge, no studies are available for small bowel transplantation using NHBDs. In an experimental setting of small bowel transplantation, we studied the feasibility of using intestinal grafts retrieved from NHBDs.


METHODS
Twenty five Large White piglets underwent total orthotopic small bowel transplantation and were randomly divided as follow: NHBD group (n = 15) received grafts from NHBDs; heart-beating donor (HBD) group (n = 10) received grafts from HBDs. The NHBD pigs were sacrificed inducing the cardiac arrest by a lethal potassium injection. After 20 minutes (no touch period = warm ischemia), they underwent cardiac massage, laparotomy, and aorta cannulation for flushing and cooling the abdominal organs. In HBDs, the cardiac arrest was induced at the time of organ cold perfusion. In both groups, immunosuppression was based on tacrolimus oral monotherapy. The animals were observed for 30 days. The graft absorptive function was studied at day 30 using the D-xylose absorption test. Histological investigation included HE (Hematoxilin and Eosin) microscopical analysis and immunohistological staining.


RESULTS
Animals in the NHBD group died due to infection (n = 3), acute cellular rejection (n = 2), technical complications (n = 2), and intestinal failure (n = 8). In the HBD group, all animals but two were alive at the end of the study. The D-xylose absorption was significantly lower among the NHBD compared with the HBD group (P < .05).


CONCLUSIONS
This study confirmed that intestinal mucosa is sensitive to ischemic injury. When the intestinal graft is harvested from NHBDs, the infectious-related mortality was higher and the absorptive function lower. Histological examination confirmed a higher grade of ischemic injury in the NHBD grafts that correlated with the clinical data. Therefore, this experimental study suggested that non-heart-beating donation may not be indicated for small bowel transplantation.
Cobianchi
L
L
Department of Surgery, University of Pavia School of Medicine and Fondazione I.R.C.C.S. Policlinico San Matteo Hospital, Pavia, Italy.
Zonta
S
S
Vigano
J
J
Dominioni
T
T
Ciccocioppo
R
R
Morbini
P
P
Bottazzi
A
A
Mazzilli
M
M
De Martino
M
M
Vicini
E
E
Filisetti
C
C
Botrugno
I
I
Dionigi
P
P
Alessiani
M
M
D000818:Animals; D001835:Body Weight; D001926:Brain Death; D006085:Graft Survival; D006323:Heart Arrest / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000637:transplantation*; D007511:Ischemia / Q000209:etiology; D019520:Living Donors; D023421:Models, Animal; D011188:Potassium / Q000633:toxicity; D013552:Swine; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014994:Xylose / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D014994:Xylose; D011188:Potassium