ALPHA-1-PROTEINASE INHIBITOR PROLONGS SMALL-INTESTINAL GRAFT PRESERVATION AND SURVIVAL

Organ preservation solutions currently used for cold storage of human donor organs are less effective in preserving small intestinal grafts than other organ grafts. The maximal safe period of cold preservation for human small intestinal graft is only about 6 hours. The pathology of preserved and reperfused small intestinal grafts is characterized b y mucosal autolysis and sloughing. The authors specu lated that the pr eservation/reperfusion injury results from a proteinase/proteinase inh ibitor imbalance in the graft that favors tissue degradation. This stu dy evaluates whether the addition of an alpha-l-proteinase inhibitor ( alpha-1-PI) to the preservation solution can improve graft survival af ter small bowel transplantation. Forty small intestinal grafts (20 cm long) were harvested from Lewis rats. The grafts were divided randomly into three groups and were preserved in one of the following solution s: normal saline (NS) (n = 10), alpha-1-PI (25 mg/mL; n = 20), or prot einase-free bovine serum albumin (BSA) (25 mg/mL; n = 10). After la-ho ur cold storage in the respective solutions, the grafts were transplan ted orthotopically into syngeneic recipients. Full thickness graft bio psies were performed before and 1 hour after revascularization. The ef fectiveness of preservation was judged by graft histopathology and rec ipient survival. Histological studies showed that there was less mucos al autolysis and sloughing of the grafts in the alpha-1-PI group than in the other two groups. All recipients in the NS and BSA groups died of graft failure within 7 days (NS: median, 4 days; range, 2 to 5 days ; BSA: median, 6 days; range, 4 to 7). However, 60% (12 of 20) of the recipients in the alpha-1-PI group survived more than 90 days (median, >90 days; range, 4 to >90 days; P <.005 v NS or BSA groups, log-rank method). These data suggest that the inclusion of alpha-1-PI in the pr eservation solution may enhance graft integrity and improve the surgic al outcome after small bowel transplantation. Copyright (C) 1996 by W. B. Saunders Company