Yang R, Liu Q, Collins M H, Grosfeld J L, Pescovitz M D
Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
J Pediatr Surg. 1996 Aug;31(8):1052-5. doi: 10.1016/s0022-3468(96)90085-8.
Organ preservation solutions currently used for cold storage of human donor organs are less effective in preserving small intestinal grafts than other organ grafts. The maximal safe period of cold preservation for human small intestinal graft is only about 6 hours. The pathology of preserved and reperfused small intestinal grafts is characterized by mucosal autolysis and sloughing. The authors speculated that the preservation/reperfusion injury results from a proteinase/proteinase-inhibitor imbalance in the graft that favors tissue degradation. This study evaluates whether the addition of an alpha-1-proteinase inhibitor (alpha-1-PI) to the preservation solution can improve graft survival after small bowel transplantation. Forty small intestinal grafts (20 cm long) were harvested from Lewis rats. The grafts were divided randomly into three groups and were preserved in one of the following solutions: normal saline (NS) (n = 10), alpha-1-PI (25 mg/mL; n = 20), or proteinase-free bovine serum albumin (BSA) (25 mg/mL; n = 10). After 12-hour cold storage in the respective solutions, the grafts were transplanted orthotopically into syngeneic recipients. Full-thickness graft biopsies were performed before and 1 hour after revascularization. The effectiveness of preservation was judged by graft histopathology and recipient survival. Histological studies showed that there was less mucosal autolysis and sloughing of the grafts in the alpha-1-Pl group than in the other two groups. All recipients in the NS and BSA groups died of graft failure within 7 days (NS: median, 4 days; range, 2 to 5 days; BSA: median, 6 days; range, 4 to 7). However, 60% (12 of 20) of the recipients in the alpha-1-PI group survived more than 90 days (median, > 90 days; range, 4 to > 90 days; P < .005 v NS or BSA groups, log-rank method). These data suggest that the inclusion of alpha-1-PI in the preservation solution may enhance graft integrity and improve the surgical outcome after small bowel transplantation.
目前用于人体供体器官冷藏的器官保存液在保存小肠移植物方面比其他器官移植物的效果要差。人体小肠移植物的最大安全冷保存期仅约6小时。保存并再灌注后的小肠移植物的病理学特征为黏膜自溶和脱落。作者推测，保存/再灌注损伤是由于移植物中蛋白酶/蛋白酶抑制剂失衡，从而导致组织降解。本研究评估在保存液中添加α-1蛋白酶抑制剂（α-1-PI）是否能提高小肠移植后移植物的存活率。从Lewis大鼠获取40个小肠移植物（长20厘米）。将移植物随机分为三组，并保存在以下溶液之一中：生理盐水（NS）（n = 10）、α-1-PI（25毫克/毫升；n = 20）或无蛋白酶牛血清白蛋白（BSA）（25毫克/毫升；n = 10）。在各自溶液中进行12小时冷保存后，将移植物原位移植到同基因受体中。在血管再通前和再通后1小时进行全层移植物活检。通过移植物组织病理学和受体存活率判断保存效果。组织学研究表明，α-1-PI组移植物的黏膜自溶和脱落比其他两组少。NS组和BSA组的所有受体均在7天内死于移植物衰竭（NS组：中位数为4天；范围为2至5天；BSA组：中位数为6天；范围为4至7天）。然而，α-1-PI组60%（20个中的12个）的受体存活超过90天（中位数，>90天；范围为4至>90天；与NS组或BSA组相比，P <.005，对数秩检验法）。这些数据表明，在保存液中加入α-1-PI可能会增强移植物完整性，并改善小肠移植后的手术效果。
