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

Publication ,  Journal Article
Abraham, N; Ludwig, EK; Schaaf, CR; Veerasammy, B; Stewart, AS; McKinney, C; Freund, J; Brassil, J; Samy, KP; Gao, Q; Kahan, R; Niedzwiecki, D ...
Published in: Transplant Direct
November 2022

UNLABELLED: 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.

Duke Scholars

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Published In

Transplant Direct

DOI

ISSN

2373-8731

Publication Date

November 2022

Volume

8

Issue

11

Start / End Page

e1390

Location

United States

Related Subject Headings

  • 3204 Immunology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Abraham, N., Ludwig, E. K., Schaaf, C. R., Veerasammy, B., Stewart, A. S., McKinney, C., … Gonzalez, L. M. (2022). Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion. Transplant Direct, 8(11), e1390. https://doi.org/10.1097/TXD.0000000000001390
Abraham, Nader, Elsa K. Ludwig, Cecilia R. Schaaf, Brittany Veerasammy, Amy S. Stewart, Caroline McKinney, John Freund, et al. “Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion.Transplant Direct 8, no. 11 (November 2022): e1390. https://doi.org/10.1097/TXD.0000000000001390.
Abraham N, Ludwig EK, Schaaf CR, Veerasammy B, Stewart AS, McKinney C, et al. Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion. Transplant Direct. 2022 Nov;8(11):e1390.
Abraham, Nader, et al. “Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion.Transplant Direct, vol. 8, no. 11, Nov. 2022, p. e1390. Pubmed, doi:10.1097/TXD.0000000000001390.
Abraham N, Ludwig EK, Schaaf CR, Veerasammy B, Stewart AS, McKinney C, Freund J, Brassil J, Samy KP, Gao Q, Kahan R, Niedzwiecki D, Cardona DM, Garman KS, Barbas AS, Sudan DL, Gonzalez LM. Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion. Transplant Direct. 2022 Nov;8(11):e1390.

Published In

Transplant Direct

DOI

ISSN

2373-8731

Publication Date

November 2022

Volume

8

Issue

11

Start / End Page

e1390

Location

United States

Related Subject Headings

  • 3204 Immunology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology