Department of General Surgery, Linyi People's Hospital, Linyi, China.
Department of Surgery, Linyi Municipal Mental Health Center, Linyi, China.
Artif Organs. 2020 Oct;44(10):1098-1106. doi: 10.1111/aor.13697. Epub 2020 May 6.
Extracorporeal membrane oxygenation (ECMO) could ameliorate the energy status and viability of bowel grafts from cardiac death donors. However, the function of these grafts after transplantation is not clear. The purpose of the study was to evaluate the early function of intestinal grafts after transplantation from expected cardiac death donors supported with normothermic extracorporeal support using a porcine allogeneic orthotopic segmental small bowel transplantation model. Eighteen domestic crossbred donor pigs were assigned to living donation (LD), donation after cardiac death (DCD), and ECMO groups. In the LD group, small bowels were harvested and preserved immediately in cold storage. In the other two groups, the donor pigs received conventional rapid recovery treatment or 1-hour normothermic extracorporeal support after 10-minutes expected cardiac arrest. Subsequently, the small bowels were removed and preserved in cold storage. After 5-6 hours of preservation, small bowel grafts were transplanted into the recipient pigs that underwent enterectomy. The pathology and electron microscopy results, cell apoptosis rate, tight junction protein expression level in the intestinal mucosa, and plasma endotoxin level were evaluated after transplantation. All grafts functioned on the basis of the maltose absorption test results at day 7 after transplantation. There were no significant differences in the morphological changes in the intestinal mucosa among the three groups at day 7 after transplantation. The cell apoptosis rate and plasma endotoxin level in the ECMO group did not differ significantly than those in the LD group, but were evidently lower than those in the DCD group (P < .001). The intestinal absorptive function improved significantly in the ECMO group in contrast with that in the DCD group (P < .001). Short-term ECMO intervention can alleviate ischemia-reperfusion injuries in intestinal grafts and improve intestinal absorptive function in the early stage after transplantation. Reducing caspase-3 protein expression and cell apoptosis in the intestinal mucosa may be one of the protective mechanisms of ECMO intervention.
体外膜肺氧合 (ECMO) 可改善心脏死亡供体的肠移植物的能量状态和活力。然而，这些移植物移植后的功能尚不清楚。本研究旨在使用猪同种异体原位节段性小肠移植模型，评估使用常温体外支持的预期心脏死亡供体支持下的肠移植物移植后的早期功能。将 18 头国内杂交供体猪分为活体捐献 (LD)、心脏死亡捐献 (DCD) 和 ECMO 组。在 LD 组，立即在冷藏中采集和保存小肠。在其他两组中，供体猪接受常规快速复苏治疗或在预期心脏骤停 10 分钟后接受 1 小时常温体外支持。随后，取出小肠并在冷藏中保存。冷藏 5-6 小时后，将小肠移植物移植到接受肠切除术的受体猪中。移植后评估病理学和电子显微镜结果、细胞凋亡率、肠黏膜紧密连接蛋白表达水平和血浆内毒素水平。根据移植后第 7 天的麦芽糖吸收试验结果，所有移植物均能正常工作。移植后第 7 天，三组肠黏膜的形态变化无明显差异。ECMO 组的细胞凋亡率和血浆内毒素水平与 LD 组无显著差异，但明显低于 DCD 组（P<0.001）。与 DCD 组相比，ECMO 组的肠吸收功能明显改善（P<0.001）。短期 ECMO 干预可减轻肠移植物缺血再灌注损伤，改善移植后早期肠吸收功能。减少肠黏膜中 caspase-3 蛋白表达和细胞凋亡可能是 ECMO 干预的保护机制之一。
