Normothermic Extracorporeal Membrane Oxygenation Support: Improves Donor Intestinal Graft Function After Cardiac Death.

Abstract

Background:Organs from cortrolled donors after cardiac death (CDCD) are particularly susceptible to the effects of warm ischaemic injury. Perfuison by normothermic extracorporeal membrane oxygenation (NECMO) is increasingly advocated as a useful remedy to the effects of ischaemia-reperfusion injury and is reported to enable transplantation of organs from donors previously deemed unsuitable. To our knowledge, no studies are available for small bowel transplantation using DCD supported by NECMO. In an experimental setting of small bowel transplantation, we studied the feasibility of using intestinal grafts retrieved from DCD supported by NECMO. Method: Thirty White piglets underwent segmental orthotopic small bowel transplantation using FK506 (0.1 mg/kg per day, POD 0-7) immunosuppression and were randomly divided as follow: Living donor (LD) group (n =6) received grafts from HBD; DCD group (n=6) received grafts from DCD; E1 group (n =6) received grafts from DCD supported by NECMO for 1 hour; E3 group (n =6) received grafts from DCD supported by NECMO for 3 hours; E5 group (n =6) received grafts from DCD supported by NECMO for 5 hours. The DCD pigs were sacrificed inducing the cardiac death by a lethal atracurium injection. After 10 minutes (no touch period time), they received NECMO support for 1, 3 or 5 hours. Histopathologic and ultrastructural analysis, mucosal tight junction protein and adenosine triphosphate concentrations were determined immediately after NECMO support. At day 7 after the transplantation, maltose absorption test and histopathologic analysis were performed. FK506 was as immunosuppression. Result: NECMO support can aggravate intestinal mucosa injury and reduce the level of mucosal tight junction protein. Energy charge could be partly increased at one hour but decrease rapidly in the subsequent stages of NECMO support. Ischemical reperfusion injury of E1 group is the lighest in all the groups after transplantation. At day 7 after the transplantation, the intestinal absorptive function of E1 group recovered quickly, which is closest to the LD group, while the DCD and E5 group recovered slowest. Conclusion: Normothermic extracorporeal membrane oxygenation support for short term could improve donor intestinal graft function after cardiac death. This is the first study in a reliable large animal transplant model demonstrating the efficacy of NECMO to rescue ischemic injured DCD intestinal grafts.