Intestinal Neuromuscular Function after Preservation and Transplantation

Abstract

While it is well known that prolonged preservation of the intestinal graft causes severe mucosal damage after transplantation, little is known about the effect on neuromuscular function. The entire small intestine of adult hound dogs was flushed and preserved with cold lactated Ringer's solution and autotransplanted either immediately (n = 6) or after 24 hr (n = 6). Animals undergoing sham operation (n = 4) were used as a control. Fasting motility and the response of the intestinal smooth muscle and enteric nerves to bethanechol (100 μg/kg/0.5 hr, iv) and cisapride (0.5 mg/kg, iv) were determined by a multiple strain gauge method on Postoperative Days 2, 4, 7, 14, 21, and 28. Compared to the control, immediately transplanted grafts and those preserved for 24 hr developed delayed reappearance of migrating myoelectric complexes (MMC), hypercontractile activity, and reduced response to bethanechol and cisapride administration. Animals in the preservation group developed more abnormal fasting motility after transplantation, but responses to bethanechol and cisapride stimulation were not markedly different from those of the immediate group. The reappearance of MMC occurred 3 weeks postoperatively in the preservation group compared to 2 days in the immediate group. The results of our study indicate that intestinal dysmotility is augmented in prolonged-preservation grafts compared to those with brief preservation. The dysmotility was transient and normalized 3 to 4 weeks after surgery. Preservation and reperfusion injury to the neuromuscular system of intestinal grafts are reversible and are attenuated by simple hypothermia.

Cadaveric small bowel/split liver transplantation in a child

“…Moreover, if a whole intestine or jejunal graft is used, it can be reimplanted in continuity with the liver, but it may be easier technically to transplant the two organs separately. Separating the two organs at the back table results in increased cold ischemia time, which adversely affects intestinal motility [7]. This factor could be responsible for the initial absence of peristaltic waves of the graft in our patient.…”

The influence of rejection on graft motility after intestinal transplantation in swine: the possibility of using this method for the real-time monitoring of acute cellular rejection

“…They concluded that the preservation time and the type of solution determined the viability of the graft. Hamada et al [22] reported that, in a transplanted dog model using lactated Ringer's solution, the reappearance of MMC in the graft occurred 2 days postoperatively in immediately transplanted group, whereas in the 24h preservation group, it took 3 weeks after transplantation. In our study, using lactated Ringer's solution and bimmediate transplantation,Q MMC reappeared by at least 5 POD in the graft, so the data obtained in this study were thought not to be affected by preservation injury.…”

Bombesin can rescue the enteric ganglia from FK506 neurotoxicity on small bowel transplantation

“…Recently, abnormal motility has been described after SBTx [16][17][18] . The imp airment of the intrinsic neural tissues has resulted in serious alterations of coordinated motility patt erns.…”