The number of small bowel transplants increased the last few years. However, one major problem is the short cold ischemic time of the small bowel. Recently it was investigated, that intestinal lipid absorption is beneficial during systemic inflammation like sepsis.
Aim: To treat organ donors with an enteral lipid solution in order to prolong cold ischemia of the small bowel.
Methods: Rats were continuously intestinally infused with either water (n=6) or an 1% olive oil solution (n=4; ClinOleic, Baxter, Germany, 3ml/h) for 12h. Thereafter rats were anesthetized, systemically infused with an organ preservation solution (Histidine-Tryptophan Ketoglutarate, HTK), then small bowel was immediately removed and stored in the HTK solution on ice. At the time periods t=0, t=60, t=120, t=180, t=240, t=300, t=360, t=420, and t=480 a tissue sample of the gut was fixed and stained with H&E. Histological examination was performed by three independent observers. A tissue damage score (0=no damage, 1=minor damage, 2=major damage, 3= loss of structure) for the basal membrane of the mucosa, the integrity of the mucosa and integrity of villi was used. The occurrence of the damage was allocated when all three observers agreed on the same or a higher damage score.
Results: Active intestinal lipid absorption before organ procurement clearly increased the cold ischemic time of the small bowel. In all control animals minor damage for the integrity of the basal membrane of the mucosa occurred within 60min, whereas only in 50% of the lipid treated rats. In all control rats, major damage for both integrity of mucosa and villi occurred within 300min or less, whereas in lipid treated rats major damage to the mucosa occurred only in 2 rats within 300min, in one after 360min and in one rat no major damage occurred. In all control animals, loss of structures for both integrity of the mucosa and villi occurred within 480min or less, whereas in lipid treated rats only 50% of the animals reached maximal damage scores for the mucosa or villi.
Conclusions: Intestinal lipid absorption before small bowl procurement clearly decreases the histological damage of the small bowel and therefore increases the cold ischemia. Lipids or their metabolites stored in the enterocytes may have some anti-inflammatory character, at least there is some evidence from studies showing a clear benefit of intestinal lipid administration during systemic inflammation like sepsis. Intestinal lipid administration in organ donors might be also a useful tool to increase cold ischemia of the small bowel in humans.