Small bowel transplantation in the rat: The adverse effect of increased pressure during the flushing procedure of the graft

Experimental orthotopic small bowel transplantation: A revised model

“…It was decided to apply a single passage perfusion prior to storage because numerous previous experiments at the Northwick Park Institute for Medical Research (Harrow, UK) had resulted in total failure of intestinal grafts when unflushed prior to transplantation (Ackroyd, unpublished data, 1989). These data confirmed previous experiments in at least one other laboratory: van Oosterhout 16 reported poor results (none of five animals survived beyond 1.5 hours), using surface cooling without flushing in a similar orthotopic model. It was considered unethical to perform experiments in which disastrous results were certain, based on previous data from our own laboratory and that of Oosterhour.…”

“…For practical reasons this technique was abandoned. Although other researchers claimed a significant adverse effect of both increased pressure 21 and decreased pressure in experimental small bowel transplantation, 22 in the pilot studies non-pressure-controlled, manual flushing of the vascular bed yielded good results. Another reason for abandoning pressure-controlled luminal washout was that it is not used commonly in the clinical situation: Todo and co-workers 23 reported aortic infusion of UWS solution without specifying infusion pressures in five cases; Grant and co-workers 24 reported non-pressure-controlled in situ flushing of a graft with 0.9% NaCl containing 2.1% mannitol in one case; Goulet and co-workers 1 used either Collins solution or UWS solution for the vascular (and luminal) flushing of six grafts without pressure control; and Deltz and co-workers 25 perfused the vascular bed and the lumen without pressure control with Euro Collins solution.…”

“…14, 15 Oosterhout 16 concluded that the clinical condition of the rat was unaffected by mesocaval shunting. In the pilot studies many alterations of the original model appeared necessary to achieve success with this type of experimental small bowel transplantation.…”

“…A bottle with the selected preservation solution was placed at a height of 35 cm, as recommended by van Oosterhout. 16 However, with this pressure, little or no effluent from the portal vein of the graft could be accomplished. Higher flushing pressures were applied simply by raising the container with the preservation solution.…”

Refined technique for intestinal transplantation in the rat

“…This is especially true for the intestinal graft, which is vulnerable to mechanical and ischemic injuries during the donor procedure. 22 Vigorous intra-luminal irrigation and in situ graft perfusion directly damage the microcirculation of the graft. We significantly reduced the volume of intraluminal irrigation (5 ml vs. 50-70 ml in Monchik and Russel's study5) and in situ graft perfusion (3-5 ml vs. [12][13][14][15][16][17][18][19][20].…”