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Optimal Solution Volume for Luminal Preservation: A Preclinical Study in Porcine Intestinal Preservation

Journal article
Authors Mihai Oltean
M. Papurica
L. Jiga
B. Hoinoiu
C. Glameanu
A. Bresler
G. Patrut
R. Grigorie
M. Ionac
Mats Hellström
Published in Transplantation Proceedings
Volume 48
Issue 2
Pages 532-535
ISSN 0041-1345
Publication year 2016
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 532-535
Language en
Links dx.doi.org/10.1016/j.transproceed.2...
Keywords transplantation, Immunology, Surgery, Transplantation
Subject categories Clinical Medicine

Abstract

Background. Rodent studies suggest that luminal solutions alleviate the mucosal injury and prolong intestinal preservation but concerns exist that excessive volumes of luminal fluid may promote tissue edema. Differences in size, structure, and metabolism between rats and humans require studies in large animals before clinical use. Methods. Intestinal procurement was performed in 7 pigs. After perfusion with histidine-tryptophan-ketoglutarate (HTK), 40-cm-long segments were cut and filled with 13.5% polyethylene glycol (PEG) 3350 solution as follows: VO (controls, none), V1 (0.5 mL/cm), V2 (1 mL/cm), V3 (1.5 mL/cm), and V4 (2 mL/cm). Tissue and luminal solutions were sampled after 8, 14, and 24 hours of cold storage (CS). Preservation injury (Chiu score), the apical membrane (Z0-1, brush-border maltase activity), and the electrolyte content in the luminal solution were studied. Results. In control intestines, 8-hour CS in HTK solution resulted in minimal mucosal changes (grade 1) that progressed to significant subepithelial edema (grade 3) by 24 hours. During this time, a gradual loss in ZO-1 was recorded, whereas maltase activity remained unaltered. Moreover, variable degrees of submucosal edema were observed. Luminal introduction of high volumes (2 mUmL) of PEG solution accelerated the development of the subepithelial edema and submucosal edema, leading to worse histology. However, ZO-1 was preserved better over time than in control intestines (no luminal solution). Maltase activity was reduced in intestines receiving luminal preservation. Luminal sodium content decreased in time and did not differ between groups. Conclusions. This PEG solution protects the apical membrane and the tight-junction proteins but may favor water absorption and tissue (submucosal) edema, and luminal volumes >2 mL/cm may result in worse intestinal morphology.

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