Reperfusion of Duodenum and Pancreas Following 24 hr of Cold Storage in Perfadex or UW Solution

Abstract

We have studied the immediate reperfusion and the graft outcome of the duodenum and pancreas separately in a porcine whole-organ pancreaticoduodenal allograft transplantation model using 24 hr of cold storage. Of 19 transplantations, 12 grafts were perfused and stored in Perfadex and 7 in University of Wisconsin (UW) solution. The organ weights before and after storage were determined in 6 grafts stored in Perfadex and 6 grafts stored in UW solution in order to quantify the degree of dehydration of the graft during storage. In 6 of the grafts perfused with Perfadex, a hyperosmotic salt dextran-containing solution (HSD) was perfused into the graft aorta at reperfusion. Duodenal reperfusion and reperfusion injury were studied by measuring mucosal pH (pHi) and by microscopic examination, respectively. Pancreatic reperfusion was studied by scoring the macroscopic appearance and microscopic examination. Daily blood glucose was used to determine the endocrine function and a secretin-chole-cystokinin stimulation test was performed on the second postoperative day to evaluate the exocrine function. All duodenal grafts except 1 in the UW group showed a sufficient reperfusion according to pHi and all had microscopic changes suggesting a moderate reper fusion injury. The macroscopic appearance of pancreas was significantly worse in the UW group than in the two Perfadex groups, Only 1 of 7 grafts in the UW group showed signs of endocrine function on the first postoperative day compared with 11 of 12 in the Perfadex groups. Our data suggest that the porcine duodenum can be cold stored in both Perfadex and UW solution for 24 hr but the pancreas does not survive cold storage in UW solution for 24 hr. Weight loss during storage was more marked in grafts stored in UW solution, indicating that dehydration may be one explanation for the decreased viability of these grafts. Similarly duodenal reperfusion in all groups makes technical failure a highly unlikely explanation for the differences in outcome of the pancreatic grafts.