Abstracts
1998 Digestive Disease Week

#1075

CHARACTERIZATION AND REDUCTION OF ISCHEMIA/ REPERFUSION-INJURY AFTER EXPERIMENTAL PANCREAS TRANSPLANTATION. H. Mayer, J. Schmidt, J. Thies, E. Ryschich, M.M. Gebhard*, Ch. Herfarth, E. Klar; Department of Surgery and *Department of Experimental Surgery, University of Heidelberg, Germany.

Reperfusion injury after pancreas transplantation with subsequent disturbance of microcirculation is a common cause of early graft pancreatitis. The aim of this study was to quantify the pancreatic microcirculation after pancreas transplantation in correlation to cold ischemia time. In the second step the effect of N-Acetylcysteine (NAC) was tested in the impaired microcirculation. Methods: In male Lewis rats we performed pancreas transplantation according to the technique of Lee in three different groups. Group 1 and 2 received no special treatment. Cold ischemia time was 1.5 (group 1) and 16 hours (group 2+3). In group 3, donor and recipient were treated with NAC (300 mg/kilogram body weight). In all three groups the grafts were perfused and stored in UW-solution. In group 1 and 2 grafts were rinsed with saline solution, grafts of group 3 were rinsed with a saline solution containing 3mg/ml NAC before implantation. 1.5 hours after reperfusion graft microcirculation was quantified by means of intravital microscopy. Rhodamine-labeled leucocytes, FITC-labeled erythrocytes and FITC-labeled albumin were used as fluorochromes. Results: After a cold ischemia time of 16 hours functional capillary density (FCD) was reduced to 106 ±  44 cm/cm2 compared to 155 ±  28 cm/cm2 after cold ischemia of 1.5 hours (p<0.05). Treatment with NAC led to a FCD of 149 ± 18 cm/cm2 (p=0.05 compared with 16 hours without treatment). Erythrocyte velocity was 0.83 ± 0.12 mm/s (1.5 hours); 0.52 ± 0.13 (16 hours) and 0.66 ± 0.12 (16 hours +NAC; p<0.05 NAC vs. control 16 hours). Leucocyte-endothelium interaction was also significantly aggravated after 16 hours ischemia time vs. 1.5 hours (10.8 vs. 7.1 Rollers/100µm venule). NAC reduced leucocyte-endothelium-interaction to 7.0 Rollers/100µm venule (p<0.05). Conclusions: Ischemia-/ Reperfusion injury after experimental pancreas transplantation is characterized by a disturbance of pancreatic microcirculation exhibiting a correlation to the duration of cold ischemia time. Erythrocyte velocity and functional capillary density were reduced, leucocyte-endothelium interaction was enhanced after a cold ischemia time of 16 hours compared to 1.5 hours. Treatment of donor and recipient with NAC resulted in a stabilisation of capillary perfusion. The clinical relevance of NAC in the reduction of ischemia/ reperfusion injury after pancreas transplantation remains to be investigated.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.