Luminal preservation of the human small bowel graft reduces mucosal damage during cold storage

A.M.S. de Jong, G. Trentadue, J. van Praagh, J. Pirenne, L.J. Ceulemans, J.W. Haveman, K.N. Faber, G. Dijkstra

Wednesday 13 march 2019

16:10 - 16:20h at Koningin Máximazaal

Categories: Best abstracts, Parallelsessie

Parallel session: Parallelsessie VI – Best abstracts I

Background: Graft survival rates in intestinal transplantation (ITx) are the lowest among solid organ transplantation^[1]. Unique for ITx is the presence of a large volume of metabolically-active luminal content consisting of a complex mixture of microbes, dietary and waste products. Cold ischemia during storage (CS) decreases mucosal integrity during preservation and leads to bacterial translocation, predisposing for rejection of the graft. CS of the bowel is limited up to 10 hours, after which it is deemed unsuitable for transplantation^[2]. Luminal preservation (LP) with polyethylene glycol (PEG) has shown promising effects in improving graft-viability in experimental models^[3][4]. We started a project to analyse the effect of luminally-applied solutions on preservation injury of the human bowel. Here, we report our preliminary data.

Methods: So far, 8 bowels from brain-dead donors from our region were included. In all cases, standard vascular perfusion (VP) with ice-cold University of Wisconsin solution (UW) was performed. Five bowels served as a control group with no LP and standard CS in UW. Three bowels were filled with 1.5 litres of PEG prior to procurement and CS. Tissue samples were taken at procurement and after 7 and 14 hours of CS. Jejunal and ileal samples were analysed for Park/Chiu score. The project has been extended to a centre in Belgium to include Institut Georges Lopez-1 (IGL-1) for VP and first results still need to be analysed.

Results: Control samples show the natural decay of the graft’s structure. Median Park/Chiu score for jejunum is 3 (maximum value=5), 4 (7) and 5 (5) in successive time points; for ileum 0 (2), 3 (4) & 4 (7) respectively. Median score with LP for jejunum is 1 (4), 3 (4) and 3.5 (4) in successive time points; for ileum 1 (2), 3 (3) & 3 (3), respectively. LP with PEG seems to maintain the epithelial lining, with increasing signs of oedema of the villi tips.

Conclusions: These promising preliminary data show that both jejunum and ileum with LP tend to maintain a low level of preservation injury. LP might thus improve graft viability and increase its preservation time-window. Further analyses will be performed to study bacterial location and protein and gene expression. Additional luminal solutions and their relationship with different VP solutions will also be studied.