Department of Surgery, University Medical Center Groningen, The Netherlands.
Transpl Int. 2011 Feb;24(2):107-31. doi: 10.1111/j.1432-2277.2010.01187.x. Epub 2010 Nov 18.
Intestinal transplantation has become the therapy of choice for patients with intestinal failure and life-threatening complications from total parenteral nutrition. Results, however, remain inferior as compared with other transplant types with the quality of the organ graft as the most important factor of outcome after transplantation. The intestine is extremely sensitive to ischemia. Unfortunately, a relatively long ischemic preservation period is inevitable. The current standard in organ preservation [cold storage (CS) with University of Wisconsin solution] was developed for kidney/liver preservation and is suboptimal for the intestinal graft despite good results for other organs. This review aimed at appraising the results from the use of previously applied and recently developed preservation solutions and techniques to identify key areas for improvement. As the studies available do not reveal the most effective method for intestinal preservation, an optimal strategy will result from a synergistic effect of different vital elements identified from a review of published material from the literature. A key factor is the composition of the solution using a low-viscosity solution to facilitate washout of blood, including amino acids to improve viability, impermeants and colloids to prevent edema, and buffer for pH-homeostasis. Optimizing conditions include a vascular flush before CS and luminal preservation. The most effective composition of the luminal solution and a practical, clinically applicable optimal technique are yet to reach finality. Short-duration oxygenated arterial and/or luminal perfusion have to be considered. Thus, a tailor-made approach to luminal preservation solution and technique need further investigation in transplant models and the human setting to develop the ultimate technique meeting the physiologic demands of the intestinal graft during preservation.
肠移植已成为治疗肠衰竭和全胃肠外营养致命并发症患者的首选方法。然而，与其他移植类型相比，其结果仍不理想，器官移植物的质量是移植后结果的最重要因素。肠道对缺血非常敏感。不幸的是，不可避免地会出现相对较长的缺血保存期。目前器官保存的标准[威斯康星大学溶液的冷藏（CS）]是为肾脏/肝脏保存而开发的，尽管对其他器官效果良好，但对肠道移植物并不理想。本综述旨在评估先前应用和最近开发的保存溶液和技术的结果，以确定需要改进的关键领域。由于现有研究并未揭示出最有效的肠保存方法，因此，通过对文献中已发表材料的综合评估，确定不同关键要素的协同作用将产生最佳策略。一个关键因素是使用低粘度溶液来改善血液冲洗，包括氨基酸以提高存活率、不可渗透物和胶体以防止水肿以及缓冲液以维持 pH 值平衡的溶液的组成。优化条件包括 CS 前的血管冲洗和管腔保存。管腔溶液的最佳组成和实用的、临床适用的最佳技术尚未最终确定。需要考虑短时间含氧动脉和/或管腔灌注。因此，需要在移植模型和人体环境中进一步研究针对管腔保存溶液和技术的定制方法，以开发满足肠移植物保存期间生理需求的最终技术。
