Human small bowel storage: the role for luminal preservation solutions

Area of Science:

• Transplantation immunology
• Organ preservation
• Gastroenterology

Background:

• Graft injury during cold storage impacts small bowel transplantation success.
• Current preservation solutions, including University of Wisconsin (UW) solution, have limitations in maintaining graft integrity for extended periods.
• Previous studies in animal models showed improved graft quality with luminal administration of preservation solutions.

Purpose of the Study:

• To investigate the clinical applicability of luminal administration of preservation solutions for human small bowel grafts.
• To assess the impact of different luminal flush solutions on graft quality during cold storage.

Main Methods:

• Human small bowel segments were obtained after procurement and flushed intra-arterially with UW solution.
• Segments were randomly divided into three groups: no luminal flush, luminal flush with UW solution, or luminal flush with an amino acid-enriched solution.
• Graft quality was analyzed over 24 hours of cold storage, assessing cellular energetics, permeability, and histologic injury.

Main Results:

• Luminal flushing (groups 2 and 3) significantly improved mucosal barrier function, with lower mannitol permeability compared to no luminal flush (group 1).
• Luminally treated specimens showed significantly less morphologic injury, with epithelial clefting observed instead of gross villus denudation.
• Preservation using luminal flush solutions demonstrated superior graft quality compared to the standard intra-arterial UW flush alone.

Conclusions:

• Luminal administration of preservation solutions is a promising strategy to enhance human small bowel graft quality.
• This approach can improve graft integrity during clinically relevant cold storage periods.
• Further clinical application of luminal flushing may improve small bowel transplantation outcomes.