Preserving the Gut: Give It What It Wants

摘要

Intestinal transplantation is gradually becoming a valid treatment modality for those suffering from intestinal failure. Numerous centers across the globe are developing Intestinal Transplant Programs, and the improvements in surgeon expertise and immune suppression are culminating in improvements in clinical outcomes. The lack of an effective intestinal-specific preservation solution is one key aspect that needs to be addressed to improve the quality of transplanted organs. Historically, the development of preservation solutions for other commonly transplanted organs has focused on an intravascular flush solution that removes blood and cools the tissue to reduce the rate of degenerative processes with little attention to tissue-specific requirements. The most important advance in organ preservation technology has been the advent of the University of Wisconsin (UW, Dupont, WI) solution. Despite the benefit of UW solution for the preservation of other organs (liver and pancreas), maximum storage time for small bowel remains relatively short (6-10 hr); furthermore, graft quality is often compromised. Because of the confines of clinical practice, it is by default that the clinical standard for intestine consists of a vascular flush with UW solution as a part of multivisceral organ procurement. Fortunately, the intestine has an alternate route of access, the lumen.