Therapeutic Impact of Nitric Oxide in Intestinal Transplantation

Intestinal transplantation is a complex technical procedure that provides patients suffering from end-stage intestinal failure an opportunity to enjoy improved quality of life, nutrition and survival. Compared to other types of organ transplants, it is a relatively new advancement in the field of organ transplantation. Nevertheless, great advances have been made over the past few decades to the present era, including the use of ischemic preconditioning, gene therapy, and addition of pharmacological supplements to preservation solutions. However, despite these strides, intestinal transplantation is still a challenging endeavor due to several factors, notable among them being ischemia-reperfusion injury (IRI), resulting in loss of cellular integrity and mucosal barrier function, graft failure, delayed graft function, and decreased graft and recipient survival. This has necessitated the search for novel therapeutic avenues and improved transplantation protocols to prevent or attenuate intestinal IRI. Among the many candidate agents that are being investigated to combat IRI and its associated complications, nitric oxide, an endogenously produced gaseous signaling molecule, is emerging as a potentially suitable candidate. The purpose of this chapter is to discuss IRI and its related complications in intestinal transplantation, and nitric oxide as an emerging pharmacological tool to improve existing intestinal transplantation protocol, minimize IRI, improve intestinal graft quality and function and prolong recipient survival after intestinal transplantation.