Segmental small bowel allograft--ischemic injury and regeneration

Purpose: Small bowel transplantation (SBT) is the ultimate treatment for intestinal failure. It remains unclear as to which intestinal segment is more suitable for use in segmental SBT. The current study aims to assess the susceptibility of various parts of small intestine to ischemia and reperfusion injury and their capacity for regeneration. Methods: Thirty-two segments of pig jejunum and ileum were isolated with intact vascular pedicles that were clamped for periods varying from 12 to 8 hours. Biopsy specimens were taken immediately before clamp release and 20 minutes afterwards. All segments were anastomosed together before abdominal closure. Laparotomy was performed 24 hours later, and biopsy specimens were taken at all segments. All specimens were examined histologically by a pathologist. Results: Evidence of injury was detected after 1.5 hours of ischemia at jejunum, but only after 5 hours at ileum. More severe injury was noted at the initial period on reperfusion, but there was no further deterioration at the later period. Complete reepithelialization occurred after 24 hours even where there had been total villous sloughing at reperfusion, but regeneration was impossible when the crypts had been damaged completely. Conclusions: Ileum, because it is more resistant to ischemia and reperfusion injury, may be preferred for segmental SBT. Regeneraiton of the bowel epithelium is fast, provided that the crypts are not damaged completely.