Cold preservation of the human colon and ileum with University of Wisconsin solution

Abstract

The inclusion of the colon in the intestinal graft resulted in worsening patient and graft outcome and increased the incidence of infection and rejection. In this study, we examine the role of ischemia on the barrier function of the epithelium during cold ischemia. Samples were collected from 15 harvested and transplanted human donor grafts (colon, 10; ileum, 6), which were immersed in University of Wisconsin (UW) solution. Ischemia (6,12,24, and 48 h) and reoxygenation were performed to evaluate the mucosal electrical status using the Ussing chamber technique. The functions of enterocytes and crypt cells were tested by glucose and theophylline challenge. Modified Park's classification was applied to evaluate the severity of mucosal damage under light microscopy.The colon had higher levels of baseline potential difference, short-circuit current, and resistance than the ileum during 6-48 h of ischemia. Colonic epithelial cells responded well to theophylline stimulation at 24 h of ischemia, while there was no ileal response. The colonic mucosa was histopathologically well preserved in UW solution for 48 h, and mucosal damage induced by reoxygenation was less than in the ileum. In conclusion, electrophysiologically and histopathologically, the colon is less susceptible to cold preservation damage than the ileum during storage with UW solution. Keywordscolon; ileum; ischemia and reoxygenation injury; small bowel transplantation; Ussing chamber Intestinal dysfunction, dysmotility, high stomal output, and rapid transit time, resulting in dehydration and malabsorption, complicate the post-operative management of small bowel transplant recipients (1-3). Common anti-diarrhetic agents have not been effective in these cases. Theoretically, the addition of the colon to the composite intestinal graft is a potential surgical solution, and indeed, the efficacy of this approach has been demonstrated both experimentally and clinically (3-5). © Munksgaard, 1999 Corresponding author: Yoshiyuki Kawashima, MD, Second Department of Surgery. Gunma University School of Medicine, 3-39-15. Showa-Machi, Mae-bashi 371-8511, Gunma, Japan.. Although the sensitivity of the small intestine to warm and cold ischemia has been well studied by morphology and biochemistry (6-10), only a few reports have examined the colon after warm ischemia (11)(12)(13)(14). In a canine model employing the Ussing chamber method, we concluded that the colon was more resistant to ischemic insult than the small bowel (15). However, our multivariate risk factor analysis of 71 clinical small transplantation cases revealed that the inclusion of the colon in the intestinal graft resulted in greater graft loss and higher levels of serum tumor necrosis factor (TNF) (1). While we no longer include the colon, there is a need to confirm the change in the barrier function of the epithelium during cold ischemia. In this study, we extend the cold ischemic preservation study to the human colon and ileum in the same manner as in our canine study. NIH Public Access Mater...

In vitro and in situ experimental model for X‐ray microanalysis of intestinal epithelium

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Translational neuropharmacology: the use of human isolated gastrointestinal tissues

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Therapeutic Effects of Xanthine Oxidase Inhibitors: Renaissance Half a Century after the Discovery of Allopurinol

“…Other than reports demonstrating increases in human gut XO activity in response to reperfusion (Wilkins et al, 1993), the clinical experience with respect to XO, allopurinol, and gut is limited to the use of the allopurinol-containing University of Wisconsin preservation solution during colon surgery (Tesi et al, 1996;Kawashima et al, 1999).…”