Preservation of Small Bowel Grafts &amp;ndash; A Comparison with Two Standard Solutions

Thaler, W.; Oberhuber, Georg; Klima, G.; Margreiter, Raimund; Schmid, T.

doi:10.1159/000129276

Cited by 12 publications

(5 citation statements)

References 7 publications

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“…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 [11–14]. 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].…”

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confidence: 79%

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

Kawashima

Takeyoshi

Furukawa

et al. 1999

Clinical Transplantation

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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...

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confidence: 79%

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

Kawashima

Takeyoshi

Furukawa

et al. 1999

Clinical Transplantation

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“…The use of UWM for the small bowel is less effective than for other organs such as the kidney, liver and pancreas (18). According to published experimental data, no currently available preservation solution could give consistent results after 24 h of small bowel preservation, although only a few studies have reported the recipient survival and graft function after preservation in a large animal model (18)(19)(20)(21)(22). Therefore, developing a more potent technique to extend the preservation time is essential for increasing the donor pool, thereby allowing more time for recipient preparation and improving patient outcome.…”

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confidence: 99%

Successful 24-h Preservation of Canine Small Bowel Using the Cavitary Two-layer (University of Wisconsin Solution/Perfluorochemical) Cold Storage Method

Tsujimura

Suzuki

Takahashi

et al. 2002

American Journal of Transplantation

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We previously developed the two-layer cold storage method (TLM), which allows sufficient oxygen delivery to the canine pancreas during preservation, and successfully achieved 96-h preservation. In this study, we applied a modified TLM (cavitary TLM) to small bowel preservation in a canine heterotopic transplant model. Using simple storage in University of Wisconsin solution (UWM, group 1, n Ω 12) or cavitary TLM (group 2, n Ω 8), 40 cm segments of the jejunum were preserved for 24 h at 4 aeC. The nonpreservation group served as the control (group 3, n Ω 8). The grafts were implanted heterotopically as a Thiry-Vella loop. Eleven of 12 dogs in group 1 died within 3 days post-transplant as a result of graft intraluminal hemorrhage, while all dogs in groups 2 and 3 survived until day 7. Histological analyses showed almost normal structures of the graft mucosa in groups 2 and 3 at day 7. Results from maltose and acetaminophen absorption tests in group 2 were comparable to those in group 3. Only one survivor in group 1 showed distinct graft mucosal damage, confirmed by histological and functional analyses. In our transplant model, the canine small bowel was successfully preserved by cavitary TLM for at least 24 h, while this preservation time was beyond the limit with UWM.

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“…A safe time period for small bowel preservation using UW solution is currently 10-12 h [18]. Because of the ineffectiveness of saline as a small bowel preservation solution after 6 h of cold ischemia [19], the measured values of the chosen parameters in groups with no cold ischemia were taken as control values.…”

Section: Discussionmentioning

confidence: 99%

Preservation Injury of Jejunal Grafts and Its Modulation by Custodiol and University of Wisconsin Perfusion Solutions in Wistar Rats

Balaz

Matia²,

Jackanin³

et al. 2004

Eur Surg Res

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Background: The two preservation solutions most commonly used in human transplantation surgery are University of Wisconsin (UW) and Custodiol (histidine-tryptophan-ketoglutarate; HTK). The aim of our study was to compare the protective effect of UW and HTK solutions on preservation-induced injury of jejunal grafts, as evaluated by the histological changes (semiquantitative method) and small bowel mucosal serotonin levels (as a possible new quantitative method). Methods: Male Wistar rats (n = 50) weighing 316 ± 52 g were divided into two main groups according to which preservation solution was used, i.e. UW (n = 25) or HTK (n = 25), and each of these groups was divided into five subgroups according to cold ischemic time (0, 1, 6, 9 and 12 h). Jejunal mucosa biopsy specimens were obtained to determine the serotonin concentration in mucosa and for standard light histology. To grade histological changes in mucosa, Park’s small bowel injury grading system was used. Results: Histological examination revealed that injury increased with cold ischemic time in the UW as well as in the HTK group, and there were no significant differences in injury between the two groups, except for the 6-hour cold ischemic period (p < 0.05), when HTK-preserved grafts showed a lower degree of injury (0.97 ± 0.41) compared with UW-preserved grafts (1.25 ± 0.39). The mucosal serotonin concentration decreased with cold ischemic time in both groups, and there were significant differences (p < 0.05) in concentrations between the groups after 9 and 12 h of cold ischemia. A significantly higher concentration was measured in grafts preserved in UW solution at these time points. Conclusion: The concentration of mucosal serotonin in rat small bowel grafts preserved for 9 and 12 h in UW preservation solution was significantly higher than that in HTK solution. These findings indicate a better protective effect of UW solution on small bowel injury after 9 h of cold ischemia.

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Preservation of Small Bowel Grafts – A Comparison with Two Standard Solutions

Cited by 12 publications

References 7 publications

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

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

Successful 24-h Preservation of Canine Small Bowel Using the Cavitary Two-layer (University of Wisconsin Solution/Perfluorochemical) Cold Storage Method

Preservation Injury of Jejunal Grafts and Its Modulation by Custodiol and University of Wisconsin Perfusion Solutions in Wistar Rats

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