ABSTRACT
Objective To analyze the surgical procedure and effect of living-related small bowel transplantation(LR-SBTx) on intestinal function failure caused by short bowel syndrome.Methods A boy, 15 years of age with short gut syndrome, who had only 8 cm of residual small intestine, associated with serious malnutrition and poor D-xylase absorption test (0.226/5h). The donor was the boy's mother. They had a match of 4 loci in HLA. In the first stage of the surgical procedure, 120 cm of ileum from the patient′s mother was transplanted into the recipient. Both ends of the transplanted intestine were exteriorized as stomas on the patient′s abdominal wall. The second stage of reconstruction of the intestine was carried out 6 months after his first operation. The residual small bowel of the recipient was transected, and both of its ends were respectively anastomosed end-to-side to the proximal and distal segments of the graft. The stomas of the graft were left in place. Results The donor and recipient operation went on smoothly. Acute rejection and infection of CMV developed postoperatively and were cured after treatment. The patient was followed-up for 8 months, the graft function recovered gradually postoperatively with increase of body weight. He can ingest a semifluid diet and take care of himself independently. Conclusions LR-SBTx is an effective way to treat short bowel syndrome. The reconstruction of the intestine in two stages for LR-SBTx decreased the risk of complications. Rejection and infection are important risk factors of LR-SBTx.
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Objective To introduce the management experience in the first cause of living-related small bowel transplantation in China. Methods An 18-year-old male patient with short gut syndrome received a living-related small bowel transplantation with the graft taken from his father(44-year-old). A segment of 150?!cm distal ileum was resected from the donor. Treatment of immunosuppression, antibiotics, antithrombosis and nutrition support were given posttransplantatively. Results Recently the recipient has a good life quality for 19 months. Conclusions Living-related small bowel trnasplantation can be effectively used to treat short gut syndrome, and the posttransplantative management is the key to the successful transplantation.
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Objective To investigate the effect of short bowel syndrome treated with living-related small bowel transplantation(SBT).Methods A male patient with residual intestine 20cm in length,which resulted from subtotal small bowel resection and right hemi-colectomy owing to intestinal volvulus,received a living-related SBT.The donor was the patient′s mother.Donor specific blood transfusion,50mL/per week,was carried out for 8 weeks.Cytomegalovirus infection status in both donor and recipient was negative.A 160cm segment of intestine was transplanted.The graft ileocolic artery and vein was anastomosed to the recipient′s infrarenal aorta and inferior vena cava end-to-side,respectively.A distal ileostomy was performed.(Immunosuppression),anti-infection and anticoagulation therapy,and nutritional support were given(postoperatively).Results The donor had an uneventful recovery.No technical complications were observed.The recipient was alive and well 31 weeks after operation.No graft rejection or infection was found.The(patient) was taken off TPN 8 weeks after operation,and got a low-fat meal.The result of D-xylose test was near normal.Conclusions Living-related small intestine transplantation is an effective treatment for short bowel syndrome.
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Objective To improve the surgical technique to establish a simple model of heterotopic segmental small bowel transplantation in rats. Methods The segmental intestine was harvested with "non-injury"technique and consisted of donor aortic segment with superior mesenteric artery and portal vein, after perfused in situ with lactated Ringer's solution, the graft was stored in 4℃ lactated Ringer's solution for about 1 h. The heterotopic segmental intestine transplantation was performed by end-to-side anastomosis of donor aorta to recipient aorta. The left kidney of the recipient was resected and the donor's portal vein was anastomosed to the recipient left renal vein by" cuff anastomosis". Results A total of 87 intestine transplantations were performed, 26 of them was regarded as formal experiment group.The average time for the arterial and venous anastomosis were 25～30min and 5 min.Among the 26 recipient rats,21 survived more than 3days.The average survival was 8.93?2.59 days, The longest survival was 14 days in this group. Conclusions It is indicated that the keys of success of small intestinal transplantation are as follows:the high quality graft,excellent anastomosis of blood vessels and adequate liquid supplement.
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Objective To determine the changes of gene expression profile in small intestinal allograft in rats after ischemic preconditioning(IPC),and to study the mechanism of graft protection of IPC.Methods Rats are randomly divided into 3 groups:sham operation(S group),small bowel transplant(SBT group)and IPC small bowel transplant group(ISBT group).Total RNAs was extracted from intestine of the 3 groups 1h after the intestine remored and cold preservation/reperfusion,and then purified to mRNA.mRNAs was then reversely transcribed to cDNA and to prepare hybridization probes.The mixed probes were hybridized to the cDNA microarray.After high-stringent washing,the fluorescent signals on cDNA microarray were scanned and analyzed.Results Among the 4 096 target genes,297 differentially expressed genes were identified between normal intestine and intestinal allograft in ISBT group;among those 84 genes which have been reported,including 18 genes expressing down and 66 genes expressing up regulation.Differentially expressing genes could be related to the protective effect of IPC.Conclusions The mechanisms of protective effect of IPC on cells of the graft are by modulation of genes related to cell adhesion,related to cellular energy and metabolism,and related to the signal transmission of the cells.
ABSTRACT
Objective To introduce the management experience in the first cause of living related small bowel transplantation in China. Methods An 18 year old male patient with short gut syndrome received a living related small bowel transplantation with the graft taken from his father(44 year old). A segment of 150?cm distal ileum was resected from the donor. Treatment of immunosuppression, antibiotics, antithrombosis and nutrition support were given posttransplantatively. Results Recently the recipient has a good life quality for 19 months. Conclusions Living related small bowel trnasplantation can be effectively used to treat short gut syndrome, and the posttransplantative management is the key to the successful transplantation.