Carolina rinse attenuates ischemia/reperfusion injury following small bowel transplantation

The manifestation of ischemia/reperfusion (I/R) injury still severely hampers success in human small bowel transplantation. Therefore, we determined the effect of flushing rat intestinal isografts with Carolina rinse (CR), as compared with Ringer's Lactate (RL). In addition, we assessed the potential to attenuate microvascular injury by prewarming the grafts using warm Rinse solutions. Intestinal ischemia/reperfusion injury was characterized by both, capillary perfusion failure within muscle and mucosa capillary network and by leukocyte accumulation in submucosal postcapillary venules (PV). Microcirculatory deterioration was paralleled by a reduction of functional density of subserosal lymphatic capillaries (FCLD). CR dramatically improved intestinal capillary perfusion and prevented leukocyte adherence within PV. Additional prewarming of CR almost completely inhibited mucosal I/R injury and was associated with a fourfold increase of FCLD, as compared to 4 degrees C RL. The results indicate, that antioxidant treatment by CR in combination with rewarming of the graft prior to reperfusion is an effective regimen to prevent leukocyte accumulation and to counteract microvascular I/R injury following small bowel transplantation.