Small bowel transplantation is an established treatment option for patients with intestinal failure. However, the short cold ischemic tolerance of the small bowel is still an imminent problem. Recently, we have shown, that the inflammatory response of the gut during abdominal sepsis was significantly reduced during oral lipid administration (Glatzle; J. Gastrointest. Sug 2007) Hypothesis: An enteral treatment with long chain fatty acids before procurement will reduce the damage of the gut during cold ischemia.
Methods: Rats were continuously intestinally infused for 12h either with NaCl, 1% olive oil or 4% olive oil (ClinOleic, Baxter, Germany, 3ml/h; n=4 each group). Thereafter rats were anesthetized, systemically infused with an organ preservation solution (Histidine-Tryptophan Ketoglutarate), the small bowel was immediately removed and stored in the HTK solution on ice. At the time periods t=0, t=2h, t=4h, t=8h, t=12h a tissue sample of the gut was fixed and stained with H&E. The tissue was analyzed by three independent observers and scored for tissue damage (0=no damage, 1=minor damage, 2=major damage, 3= loss of structure) of the basal membrane of the mucosa, the integrity of the mucosa and integrity of villi. Data are represented as median.
Results: Both lipid pretreated groups reached after 4 h of cold ischemia a median damage score of 2 for the integrity of the basal membrane, whereas the control group reached a damage score of 3. The 1% olive oil treated rats showed either no damage or minor damage to the mucosa after 4 h of cold ischemia, whereas in the control group 75% of the animals had at least minor damage scores up to loss of structures. The most impressing results were seen in the lipid pretreated groups regarding the integrity of the villi. None of the 1% lipid treated animals showed a damage for the integrity of villi within 4h of cold ischemia, whereas 50% of the control animals showed al least minor damage scores. (median damage score for the integrity of villi, control: 0h: 0; 2h: 0; 4h: 0.5; 8h:1.5; 12h: 2; 1%lipid: 0h: 0; 2h: 0; 4h: 0; 8h:1; 12h: 1.5; 4% lipid: 0h: 0; 2h: 0; 4h: 0; 8h:2; 12h: 3).
Conclusions: Intestinal lipid absorption before gut procurement clearly decreases the histological damage of the small bowel during cold ischemia and 1% olive oil seems to be more efficient than 4%. Lipids or their metabolites stored in the enterocytes may have some anti-inflammatory character. Intestinal lipid administration in organ donors might also be a useful tool to increase cold ischemia of the small bowel in humans.