Warm ischemia of the intestine is a medical emergency which results from
mesenteric vascular occlusion. In addition, intestinal
transplantation techniques will also inevitably result in intestinal
ischemia. The recovery of organ function following
ischemia depends on the extent of irreversible damage produced by the
ischemia and the extent of reflow upon reperfusion. In some organs energy homeostasis has been found to correlate with organ recovery and graft survival following
ischemia-reperfusion. Investigating the usefulness of the determination of
adenine and
pyridine nucleotides as indicators of the extent of ischemic injury in intestinal segments, we found that after an initial 40% decrease in
ATP following 30 min of
ischemia there was no further decrease despite increasing the
ischemia period to 120 min. Similarly, the decrease in NAD+ and
NADP which occurred after 30 min of
ischemia did not decrease further after 60, 90, or 120 min of
ischemia.
Xanthine was the only biochemical where an increase appeared to correlate with
ischemia duration while energy charge was of no value in indicating injury extent. Additionally, after reperfusion there was at best a poor correlation between recovery of
ATP content and the duration of
ischemia. Microcirculation reflow after reperfusion indicated
ischemia time-related endothelial cell injury. Thus, the measurement of high-energy
phosphates in intestinal segments is not of value as an
indicator of the extent of intestinal ischemic injury.