|
|
Back to 2015 Annual Meeting Program
Extracorporeal Hypothermic Perfusion Device for Human Intestine Preservation to Decrease Ischemic Injury During Graft Transportation
Armando Salim Munoz-Abraham*1, Roger Patron-Lozano2, Tariq I. Alfadda2, Sami S. Judeeba2, Abedalrazaq Alkukhun2, Raja R. Narayan3, Yusuf Chauhan4, Joseph T. Belter5, Raffaella Morotti6, Joseph P. Zinter5, Manuel I. Rodriguez-Davalos1, John P. Geibel2
1Surgery/Transplant, Yale School of Medicine, New Haven, CT; 2Surgery, Yale University School of Medicine, New Haven, CT; 3Khan Academy, Orange County, CA; 4Yale University, New Haven, CT; 5School of Engineering & Applied Science, Yale University, New Haven, CT; 6Pathology, Yale University School of Medicine, New Haven, CT
Introduction: Although the intestine is one of the most ischemia-sensitive organs used for transplantation, little has changed in the crucial intermediary step of preserving the organ during transportation. Since the inception of intestinal transplantation, the standard of care remains static cold preservation. In attempting to increase the chances of intestinal graft survival, we developed an innovative design for extracorporeal perfusion. We previously presented a novel Intestinal Perfusion Unit (IPU) for improving the extracorporeal survival of the graft by perfusing both the intestinal lumen and mesentery of a porcine model. We present this year results from the first perfused human intestine which is compared with a paired classically maintained cold immersion.
Design: A human intestinal graft (jejunum-ileum) was procured with standard technique after research consent was obtained through an organ procurement organization. The specimen was divided in two sections: The experimental intestine connected to the IPU, was continuously perfused with standard preservation solution (SPS) and a control intestine that was placed in an organ transportation bag immersed in cold SPS (cold static preservation) for eight hours.
Methods: Approximately 3 meters of intestine were procured. 2.7 meters were connected to the IPU (Group 1) and 30 centimeters were preserved in static cold SP solution with ice (Group 2). The intestine connected to the IPU had two circuits connected to separate peristaltic pumps, (1) vasculature (open circuit with recirculating filter) and (2) lumen (closed circuit). The graft in Group 1 was perfused with SPS at 4-80C at a constant rate with peristaltic flows of 100 ml/min for the vasculature, and 150 ml/min for the lumen. After 8 hours, samples from both groups were obtained and immersed in 10% formalin for 24 hours. The samples were sent for blinded pathologic analysis to be classified with the Park/Chiu scoring system for intestinal ischemia.
Results: The pathology analysis showed that for the Ileum, the IPU led to a better pathological preservation after 8 hours. Pathological scoring showed some denuded tips (Grade 3), whereas the control sample (non-perfused, cold storage) showed disintegration of the lamina propria (Grade 5).
Conclusion: We now present evidence in human intestine that the IPU extends the viability of human intestine compared to the present standard of care. These findings suggest that continuous perfusion of the small bowel with cold preservation solutions increases viability of the specimen. Our early results with human intestine can eventually lead to expanding the possibilities of optimal intestinal preservation for transplantation to address this continuing unmet need.
Back to 2015 Annual Meeting Program
|
