P3.24: First clinical multi-center experience of IGL-1 for intestinal graft preservation
Canovai, Emilio1,,2; Oltean, Mihai3; Herlenius, Gustaf3; Trentadue, Guido4; Dijkstra, Gerard4; Haveman, Jan4; Pascher, Andreas5; Monbaliu, Diethard1,,2; Pirenne, Jacques1,,2; Ceulemans, Laurens1,,2
1Leuven Intestinal Failure and Transplantation (LIFT) center, Abdominal Transplant Surgery, University Hospitals Leuven, Belgium
2Abdominal Transplant Department, University Hospitals Leuven, Belgium
3Intestinal Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
4Groningen Transplant Center, University Medical Center Groningen, University of Groningen the Netherlands
5Universitatsklinikum Munster Klinik und Poliklinik fur Allgemein- und Viszeralchirurgie, Dept. of Visceral and Transplant Surgery
Introduction: The gold standard for intestinal allograft preservation is University of Wisconsin solution (UW). In animal models, Institute Georges Lopez solution (IGL-1) improved intestinal graft viability and epithelial repair compared to UW. It is an extra-cellular preservation solution with high sodium and low potassium content in contrast to UW and presence of polyethylene glycol, resulting in lower viscosity. The aim of this study is to evaluate IGL-1, for the first time, as a preservation solution for clinical intestinal transplantation (ITx).
Methods: We performed a retrospective analysis (January 2014 to April 2018) of all ITx where the graft was preserved using IGL-1 in 4 European centers.
Results: Thirteen ITx were performed in 13 patients (1 child / 12 adults, 7 females / 6 males) for short bowel syndrome (n=7), motility disorder (=4) and diffuse portomesenteric thrombosis (n=2). Seven multivisceral and 6 isolated grafts were transplanted. Vascular perfusion with 4–6 liters of IGL-1 was used without luminal preservation. Median cold ischemia time was 485 minutes (range: 192–840 minutes).
In all cases, the bowel appeared macroscopically well vascularized after reperfusion with minimal signs of reperfusion edema. Histology after reperfusion was available in 3/13 cases, with a maximal Park/Chiu score of 2.
One-year graft survival was 76%. Three patients required a transplantectomy (1 for CMV reactivation, 2 for refractory cellular rejection). Two patients died after transplantectomy: 1 from intestinal failure associated liver disease and 1 from bacterial sepsis, resulting in a 1-year patient survival of 83%. Ten patients are alive with a functioning graft and one requires parenteral nutrition following transplantectomy.
Conclusion:This multicenter experience suggests that IGL-1 can safely be used for preservation of intestinal grafts with good short-term results, comparable to the results from the International Intestinal Transplant Registry. Further histological data is being collected from all centers to evaluate preservation capacity of IGL-1.
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