Intestinal decontamination using povidone-iodine compromises small bowel storage quality.

Background: Povidone-iodine (PI) (Betadine, Purdue Fredrick Co., Norwalk, CT) is used during pancreas transplantation to provide duodenal decontamination without any intestinal complications.

Methods: This study assessed the combined effect of a luminal pretreatment with PI followed by a proven amino acid (AA)-rich preservation solution on small bowel (SB) storage quality. Rat SB was procured using intra-arterial University of Wisconsin solution followed by luminal administration with combinations of AA+/-PI pretreatment as follows: group 1, 20 mL AA solution; group 2, 20 mL PI and 20 mL AA solution; group 3, 100 mL AA solution; and group 4, 20 mL PI and 100 mL AA solution. Cellular energetics, permeability, and histology were analyzed throughout 10-hr cold storage.

Results: After 10 hr, adenosine triphosphate levels remained 2.9 to 3.2 micromol/g protein lower in the PI-treated groups than in groups 1 and 3. Functional parameters were also negatively affected by PI treatment. Mannitol permeability was 203 and 66 nmol/cm2 per hr in groups 2 and 4 versus 46 and 44 nmol/cm2 per hr in groups 1 and 3. Median grades of histologic injury (Park's) at 10 hr were 3, 5.5, 4, and 5 for groups 1 through 4, respectively. Luminal flushing with PI or AA solution resulted in an equivalent clearance greater than 95% of enteric bacteria present.

Conclusions: hort-duration luminal PI exposure potentiates SB injury and provides no improved intestinal decontamination.