Oxygen Insufflation in University of Wisconsin Solution Ameliorates Reperfusion Injury in Small Bowel after Cold Storage and Reperfusion.
BACKGROUND Results in small bowel transplantation are inferior compared to other solid organ transplantations, among other reasons, due to a specific vulnerability to ischemia/reperfusion injury. New strategies are needed to improve organ storage. Here we compare static cold storage in University of Wisconsin solution to storage supplemented with molecular oxygen gas insufflation. MATERIAL AND METHODS Rat small bowel was retrieved and either stored unoxygenated (UW) or oxygenated (UW+O2) for 18 h at 4°C. Biochemical parameters, mucosal function, Toll-like receptor upregulation, and parameters of structural integrity were evaluated following isolated reperfusion in vitro for 30 min at 37°C. RESULTS Oxygenation showed: ATP concentration was 82 times higher; lactate dehydrogenase release was continuously lower over 30 min; malondialdehyde, a final product of lipid peroxidation (UW+O2 vs. UW; 2.7±0.92 nmol/mL vs. 17.22±10.1 nmol/mL; P<0.05) and nitric oxide concentration (0.87±0.27 µmol/L vs. 2.17±0.29 µmol/L; P<0.001) were significantly lower; whereas mucosal functional integrity (galactose uptake) was better preserved (0.47±0.18 mg/dL vs. 0.35±0.05 mg/dL). Amelioration of tissue damage could be demonstrated by reduced apoptosis (3.3±1.2 AU vs. 28.4±10 AU; P>0.05), and preserved subcellular integrity. Toll-like receptors were significantly less upregulated (TLR2 0.32±0.1 vs. 2.1±1.5-fold and TLR4 1.53±1.14 vs. 11.79±5.4-fold; P<0.05). CONCLUSIONS Oxygenated storage is superior to standard storage in University of Wisconsin solution in terms of energetics, tissue damage, and mucosal integrity.
Department of Surgery, University of Bonn, Bonn, Germany.
Tim R
TR
Glowka
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
Lai
L
Wei
Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Koichiro
K
Hata
Division of Veterinary Pathology, Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University, Aachen, Germany.
Mamdouh
M
Afify
Department of Surgery, University of Bonn, Bonn, Germany.
Jörg C
JC
Kalff
Division of Surgical Research, Department of Surgery, University of Bonn, Bonn, Germany.
Thomas
T
Minor
Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen University, Aachen, Germany.
René H
RH
Tolba
D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D005978:Glutathione; D007327:Insufflation / Q000379:methods*; D007328:Insulin; D007421:Intestine, Small / Q000098:blood supply* / Q000637:transplantation*; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010100:Oxygen / Q000627:therapeutic use*; D011887:Raffinose; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000517:prevention & control*
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose; D010100:Oxygen