2011 - ISBTS 2011 Symposium
Oral Communications 2: Ischemia / Reperfusion
4.116 - Viability of the human small bowel graft in the scope of intestinal transplantation (ITx)
Presenter: Anne Margot, Roskott, Groningen, Netherlands, Netherlands
Authors: Anne Margot Roskott1, Henri Leuvenink1, Gerard Dijkstra2, Rutger Ploeg1, Harry van Goor3, Vincent Nieuwenhuijs1
Viability of the human small bowel graft in the scope of intestinal transplantation (ITx)
Anne Margot Roskott1, Henri Leuvenink1, Gerard Dijkstra2, Rutger Ploeg1, Harry van Goor3, Vincent Nieuwenhuijs1
1Department of Transplantation & Organ Donation, University Medical Center Groningen (UMCG), Groningen, Netherlands; 2Department of Gastroenterology and Hepatology, UMCG, Groningen, Netherlands; 3Department of Pathology, UMCG, Groningen, Netherlands
Introduction: Results of ITx remain inferior compared to other transplant types. The extreme susceptibility of the intestine to transplant related graft damage must play a major role. The effects of brain death (BD) and ischemia on the intestine are largely unknown. However, differences in extent of graft damage between donor types are assumed since grafts from non-heart beating donors (DCD) are discarded for ITx. This descriptive study was designed to assess intestinal graft viability and gain insight in pathophysiological mechanisms.
Methods: Patient data, blood and intestinal samples were collected during multi-organ-donation (MOD:DBD/DCD) after aortic flush. Control blood was collected from living kidney donors. Outcome parameters: histological Park score (0-8), Claudine-3 stain (Clau-3)), IL-6 western blot, serum lipopolysaccharide binding protein (LBP) and CRP).
Results: Donor descriptives: table 1.
Histology: Mean jejunal/ileal Park score was 3.9 (denuded villi)/ 2.9 (extensive epithelial lifting); indicating more jejunal damage (p=.032). Ileal damage was worse in DCD compared to DBD (p=.038). Optimal donors were selected (OPTN criteria for potential donation). A trend for better ileal histology was seen in optimal donors (p=.056). BD/ischemia times were unrelated to histology. Optimal donors revealed better jejunal and ileal integrity (clau-3, (p=.03). Serum markers: CRP/LBP levels were higher in both DBD/DCD donors versus control (p<.001-.004). These levels did not differ between deceased donor types and were unrelated to histology.
Western Blot: Local inflammation (Il-6 expression) was higher in DBD versus DCD (p=.046).
Conclusion: The Jejunum is structurally more susceptible than ileum and more structural ileal damage is seen in DCD versus DBD. Superior integrity (Clau-3) in optimal donors suggests a negative effect of ischemia in DCD. Intestinal Il-6 expression in DBD suggests a primarily inflammatory effect of BD. However, equally elevated levels of LBP/CRP in both donor types ultimately indicate the same degree of barrier dysfunction and systemic inflammation. Development of protective strategies to counteract these processes will be a major step towards improvement of ITx.
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