Effects of Cold Preservation on Intestinal Grafts from Donation after Circulatory Death and Brain Death Donors in an Experimental Model.

INTRODUCTION

Donation after circulatory death (DCD) has been successfully implemented in several solid organs, but its biological impact on intestinal grafts remains underexplored. Understanding how DCD grafts tolerate cold ischemia compared to those from brain-dead (BD) donors is crucial to refine preservation strategies and expand the donor pool.

METHODS

Adult male Wistar rats were assigned to three groups according to donor condition: ventilated living donor, brain death (BD), and DCD. Jejunal segments were flushed with histidine-tryptophan-ketoglutarate solution and stored at 4°C for 0, 4, and 12 h. Histological injury was assessed using the Park-Chiu scale, villus/crypt ratio, mucosal thickness, and effective villus density. Goblet cell counts and immunohistochemistry for CD3 and E-cadherin were also performed.

RESULTS

Global and focal ischemic damage progressed similarly across donor types during cold preservation. DCD grafts maintained stable villus/crypt ratio and mucosal thickness values throughout 12 h, while BD grafts showed greater deterioration (P < 0.01). Villus density declined over time in both BD and DCD groups, whereas ventilated living donor remained stable. Goblet cell loss correlated with cold ischemia duration rather than donor condition. CD3+ T-cell infiltration was significantly higher in BD grafts, indicating a stronger inflammatory baseline.

CONCLUSIONS

Intestinal grafts from DCD donors demonstrate comparable tolerance to cold ischemia as BD grafts, with more stable mucosal architecture and a less proinflammatory profile at procurement. These findings challenge historical concerns about intestinal ischemic susceptibility and support DCD as a viable source for intestinal transplantation. Subtle structural and immunological differences between donation types warrant further investigation regarding their clinical relevance.