Optimal Solution Volume for Luminal Preservation: A Preclinical Study in Porcine Intestinal Preservation.
BACKGROUND
Rodent studies suggest that luminal solutions alleviate the mucosal injury and prolong intestinal preservation but concerns exist that excessive volumes of luminal fluid may promote tissue edema. Differences in size, structure, and metabolism between rats and humans require studies in large animals before clinical use.


METHODS
Intestinal procurement was performed in 7 pigs. After perfusion with histidine-tryptophan-ketoglutarate (HTK), 40-cm-long segments were cut and filled with 13.5% polyethylene glycol (PEG) 3350 solution as follows: V0 (controls, none), V1 (0.5 mL/cm), V2 (1 mL/cm), V3 (1.5 mL/cm), and V4 (2 mL/cm). Tissue and luminal solutions were sampled after 8, 14, and 24 hours of cold storage (CS). Preservation injury (Chiu score), the apical membrane (ZO-1, brush-border maltase activity), and the electrolyte content in the luminal solution were studied.


RESULTS
In control intestines, 8-hour CS in HTK solution resulted in minimal mucosal changes (grade 1) that progressed to significant subepithelial edema (grade 3) by 24 hours. During this time, a gradual loss in ZO-1 was recorded, whereas maltase activity remained unaltered. Moreover, variable degrees of submucosal edema were observed. Luminal introduction of high volumes (2 mL/mL) of PEG solution accelerated the development of the subepithelial edema and submucosal edema, leading to worse histology. However, ZO-1 was preserved better over time than in control intestines (no luminal solution). Maltase activity was reduced in intestines receiving luminal preservation. Luminal sodium content decreased in time and did not differ between groups.


CONCLUSIONS
This PEG solution protects the apical membrane and the tight-junction proteins but may favor water absorption and tissue (submucosal) edema, and luminal volumes >2 mL/cm may result in worse intestinal morphology.
University of Medicine and Pharmacy Timisoara, Romania; Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. Electronic address: mihai.oltean@surgery.gu.se.
M
M
Oltean
University of Medicine and Pharmacy Timisoara, Romania.
M
M
Papurica
University of Medicine and Pharmacy Timisoara, Romania; School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany.
L
L
Jiga
University of Medicine and Pharmacy Timisoara, Romania.
B
B
Hoinoiu
University of Medicine and Pharmacy Timisoara, Romania.
C
C
Glameanu
University of Medicine and Pharmacy Timisoara, Romania.
A
A
Bresler
University of Medicine and Pharmacy Timisoara, Romania.
G
G
Patrut
Fundeni Clinical Institute, Bucharest, Romania.
R
R
Grigorie
University of Medicine and Pharmacy Timisoara, Romania.
M
M
Ionac
Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
M
M
Hellström
D000818:Animals; D015925:Cryopreservation / Q000379:methods*; D005947:Glucose / Q000494:pharmacology; D007422:Intestines / Q000187:drug effects*; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D013552:Swine
C039984:Bretschneider cardioplegic solution; D019188:Organ Preservation Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose