Introduction: Static cold storage (SCS) has been the traditional method for organ preservation in transplantation. Nevertheless, ex situ perfusion systems are emerging as a promising alternative, demonstrating their utility in the evaluation, optimization, and extension of organ viability for organs such as the liver, kidney, and lung. Despite these advances, the recognized vulnerability of the intestine has limited their inclusion in intestinal transplantation (IT). In this work, we present a comparative study between SCS, normothermic perfusion (NP), and hypothermic oxygenated perfusion (HOPE) in an experimental model of IT
Methods: A prospective comparative study was conducted where 48 white pigs (25-30 kg, 24M-24F) were randomized as donors and recipients (n=24/group). Intestinal grafts were preserved for 4 hours using SCS, NP or HOPE (n=8/group) and heterotopic IT was performed. Recipients were monitored for 14 days, collecting intestinal samples for histological analysis (Chiu-Park and Wu scoring) and gene expression assessment during procedure, preservation and on postoperative days 1, 2, 7 and 14. Graft function was assessed by glucose absorption test at the endpoint.
Results: Survival was 100% in all groups. There were no significant differences in epithelial integrity [SCS 2 (0-3), NP 3 (1-4), HOPE 2 (1-3), p>0.05], rejection [SCS 2, NP 1, HOPE 1, p>0.05] or graft-versus-host disease [SCS 2, NP 3, HOPE 3, p>0.05]. TNF-α levels were higher in NP group (p<0.05). The absorption test showed no differences between the groups (p>0.05).
Conclusions: Ex situ perfusion systems are not inferior to SCS in an experimental model of IT. Both NP and HOPE had similar outcomes. Further research is warranted to define the role of this technologies on intestinal graft validation and preconditioning.