Cobianchi L, Zonta S, Vigano J, Dominioni T, Ciccocioppo R, Morbini P, Bottazzi A, Mazzilli M, De Martino M, Vicini E, Filisetti C, Botrugno I, Dionigi P, Alessiani M
Department of Surgery, University of Pavia School of Medicine and Fondazione I.R.C.C.S. Policlinico San Matteo Hospital, Pavia, Italy.
Transplant Proc. 2009 Jan-Feb;41(1):55-6. doi: 10.1016/j.transproceed.2008.08.151.
The shortage of organs in the last 20 years is stimulating the development of new strategies to expand the pool of donors. The harvesting of a graft from non-heart-beating donors (NHBDs) has been successfully proposed for kidney and liver transplantation. To our knowledge, no studies are available for small bowel transplantation using NHBDs. In an experimental setting of small bowel transplantation, we studied the feasibility of using intestinal grafts retrieved from NHBDs.
Twenty five Large White piglets underwent total orthotopic small bowel transplantation and were randomly divided as follow: NHBD group (n = 15) received grafts from NHBDs; heart-beating donor (HBD) group (n = 10) received grafts from HBDs. The NHBD pigs were sacrificed inducing the cardiac arrest by a lethal potassium injection. After 20 minutes (no touch period = warm ischemia), they underwent cardiac massage, laparotomy, and aorta cannulation for flushing and cooling the abdominal organs. In HBDs, the cardiac arrest was induced at the time of organ cold perfusion. In both groups, immunosuppression was based on tacrolimus oral monotherapy. The animals were observed for 30 days. The graft absorptive function was studied at day 30 using the D-xylose absorption test. Histological investigation included HE (Hematoxilin and Eosin) microscopical analysis and immunohistological staining.
Animals in the NHBD group died due to infection (n = 3), acute cellular rejection (n = 2), technical complications (n = 2), and intestinal failure (n = 8). In the HBD group, all animals but two were alive at the end of the study. The D-xylose absorption was significantly lower among the NHBD compared with the HBD group (P < .05).
This study confirmed that intestinal mucosa is sensitive to ischemic injury. When the intestinal graft is harvested from NHBDs, the infectious-related mortality was higher and the absorptive function lower. Histological examination confirmed a higher grade of ischemic injury in the NHBD grafts that correlated with the clinical data. Therefore, this experimental study suggested that non-heart-beating donation may not be indicated for small bowel transplantation.
过去20年中器官短缺促使人们开发新策略以扩大供体库。已成功提出从非心脏跳动供体（NHBD）获取移植物用于肾和肝移植。据我们所知，尚无关于使用NHBD进行小肠移植的研究。在小肠移植的实验环境中，我们研究了使用从NHBD获取的肠移植物的可行性。
25只大白仔猪接受全原位小肠移植，并随机分为以下两组：NHBD组（n = 15）接受来自NHBD的移植物；心脏跳动供体（HBD）组（n = 10）接受来自HBD的移植物。通过注射致死剂量的钾诱导心脏骤停处死NHBD组的猪。20分钟后（无触摸期=热缺血），对其进行心脏按摩、剖腹术及主动脉插管，以冲洗和冷却腹部器官。对于HBD组，在器官冷灌注时诱导心脏骤停。两组均采用他克莫司口服单一疗法进行免疫抑制。对动物观察30天。在第30天使用D-木糖吸收试验研究移植物的吸收功能。组织学检查包括苏木精和伊红（HE）显微镜分析及免疫组织化学染色。
NHBD组的动物死于感染（n = 3）、急性细胞排斥（n = 2）、技术并发症（n = 2）和肠衰竭（n = 8）。在HBD组，研究结束时除两只动物外所有动物均存活。与HBD组相比，NHBD组的D-木糖吸收显著降低（P <.05）。
本研究证实肠黏膜对缺血性损伤敏感。当从NHBD获取肠移植物时，感染相关死亡率更高且吸收功能更低。组织学检查证实NHBD移植物中缺血性损伤程度更高，这与临床数据相关。因此，本实验研究表明非心脏跳动供体可能不适用于小肠移植。
