Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion.

Abstract

Successful intestinal transplantation is currently hindered by graft injury that occurs during procurement and storage, which contributes to postoperative sepsis and allograft rejection. Improved graft preservation may expand transplantable graft numbers and enhance posttransplant outcomes. Superior transplant outcomes have recently been demonstrated in clinical trials using machine perfusion to preserve the liver. We hypothesized that machine perfusion preservation of intestinal allografts could be achieved and allow for transplantation in a porcine model.

Methods

Using a translational porcine model, we developed a device for intestinal perfusion. Intestinal samples were collected at the time of organ procurement, and after 6 h of machine perfusion for gross and histologic evaluation, hourly chemistry panels were performed on the perfusate and were used for protocol optimization. Following transplantation, porcine recipient physical activity, systemic blood parameters, and vital signs were monitored for 2 d before sacrifice.

Results

In initial protocol development (generation 1, n = 8 grafts), multiple metabolic, electrolyte, and acid-base derangements were measured. These factors coincided with graft and mesenteric edema and luminal hemorrhage and were addressed with the addition of dialysis. In the subsequent protocol (generation 2, n = 9 grafts), differential jejunum and ileum perfusion were observed resulting in gross evidence of ileal ischemia. Modifications in vasodilating medications enhanced ileal perfusion (generation 3, n = 4 grafts). We report successful transplantation of 2 porcine intestinal allografts after machine perfusion with postoperative clinical and gross evidence of normal gut function.

Conclusions

This study reports development and optimization of machine perfusion preservation of small intestine and successful transplantation of intestinal allografts in a porcine model.

Department

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Citation

Published Version (Please cite this version)

10.1097/txd.0000000000001390

Publication Info

Abraham, Nader, Elsa K Ludwig, Cecilia R Schaaf, Brittany Veerasammy, Amy S Stewart, Caroline McKinney, John Freund, John Brassil, et al. (2022). Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion. Transplantation direct, 8(11). p. e1390. 10.1097/txd.0000000000001390 Retrieved from https://hdl.handle.net/10161/26278.

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Scholars@Duke

Niedzwiecki

Donna Niedzwiecki

Professor of Biostatistics & Bioinformatics

Primary interests include clinical trials design and the design and analysis of biomarker and imaging studies especially in the areas of GI cancer, lymphoma, melanoma, transplant and cancer immunotherapy.

Cardona

Diana Marcella Cardona

Associate Professor of Pathology

I am active in translational research involving gastrointestinal/hepatobiliary pathology [specifically transplant related pathology (GVHD and rejection) and carcinogenesis of the pancreas] and bone and soft tissue malignancies [imaging techniques for intraoperative margin assessment].

Garman

Katherine Schuver Garman

Associate Professor of Medicine

My research focuses on injury, repair, and cancer development in the gastrointestinal tract. My laboratory performs translational research with the goal of improving health of the gastrointestinal tract. Our work is based in observations from human clinical research. We use databases of esophageal and colon disease to learn more about clinical risk factors for disease. We also use pathology samples of tumors to study the gastrointestinal tract in different states: healthy, inflamed or damaged, and with cancer.

Barbas

Andrew Serghios Barbas

Associate Professor of Surgery
Sudan

Debra L Sudan

Professor of Surgery

I am interested clinically in all abdominal organ transplants (kidney, liver, pancreas and intestine).  I am specifically interested in intestine transplantation and improving intestine graft preservation and long-term graft function and patient survival.  In addition, I am interested in monitoring of patients to improve our ability to determine the etiology of graft dysfunction when there are complex interacting issues such as infection and rejection as well as examining better immunosuppressive regimens to maintain excellent graft function.  We have numerous research studies and trial to improve our knowledge in these areas and thereby contribute to improved patient outcomes!


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