Small bowel preservation for intestinal transplantation: a review

Abstract

Summary Intestinal transplantation has become the therapy of choice for patients with intestinal failure and life‐threatening complications from total parenteral nutrition. Results, however, remain inferior as compared with other transplant types with the quality of the organ graft as the most important factor of outcome after transplantation. The intestine is extremely sensitive to ischemia. Unfortunately, a relatively long ischemic preservation period is inevitable. The current standard in organ preservation [cold storage (CS) with University of Wisconsin solution] was developed for kidney/liver preservation and is suboptimal for the intestinal graft despite good results for other organs. This review aimed at appraising the results from the use of previously applied and recently developed preservation solutions and techniques to identify key areas for improvement. As the studies available do not reveal the most effective method for intestinal preservation, an optimal strategy will result from a synergistic effect of different vital elements identified from a review of published material from the literature. A key factor is the composition of the solution using a low‐viscosity solution to facilitate washout of blood, including amino acids to improve viability, impermeants and colloids to prevent edema, and buffer for pH‐homeostasis. Optimizing conditions include a vascular flush before CS and luminal preservation. The most effective composition of the luminal solution and a practical, clinically applicable optimal technique are yet to reach finality. Short‐duration oxygenated arterial and/or luminal perfusion have to be considered. Thus, a tailor‐made approach to luminal preservation solution and technique need further investigation in transplant models and the human setting to develop the ultimate technique meeting the physiologic demands of the intestinal graft during preservation.

Effect ofCXCR3/HO-1genes modified bone marrow mesenchymal stem cells on small bowel transplant rejection

“…In recent years, with improvements in surgical transplantation, immunosuppressive regimens, prevention of infection, and other key technological advances, small bowel transplantation has become an effective treatment for intestinal failure[1-4]. Currently, small bowel transplantation poses more clinical problems compared with transplantation of other organs such as the liver and kidney[5].…”

Adoptive Infusion of Tolerogenic Dendritic Cells Prolongs the Survival of Pancreatic Islet Allografts: A Systematic Review of 13 Mouse and Rat Studies

“…These non-immunologic factors play a key role in graft survival, separately or synergistically, such as seen in ischemia-reperfusion injury (IRI), infection, disease stage, graft preservation, and operation difficulty [23], [24].…”

Combination Therapy of Tacrolimus and Infliximab Reduces Inflammatory Response and Dysmotility in Experimental Small Bowel Transplantation in Rats

“…According to current preservation strategies, the graft was stored in cold University of Wisconsin solution for 30 min during the preparation of the recipient (41). Warm ischemia time lasted another 30 min while the end-to-side anastomosis between the graft vein and the recipient vena cava was performed.…”