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Objective To study the effect of hypothermia mechanical perfusion (HMP) preservation on microcirculation injury of isolated pig small intestine.Methods Ten healthy Bama miniature pigs were selected.The experimental animals were randomly divided into two groups.In HMP group (n =5),the intestine of 200 cm in length and corresponding blood vessels were cut and then connected to HMP storage device at 4 ℃ for 6 h.In UW group (n =5),the intestine of 200 cm in length and corresponding blood vessels were cut and then preserve in 4 ℃ UW solution for 6 h.Situ small intestine transplantation was performing when preservation finished.The serum NO and ET-1,the dry-wet ratios of intestine tissue,blood flow velocity of intestinal microcirculation and pathological changes of tissues were detected before and after preservation.Results There was no significant difference in serum ET-1 and NO between HMP group and UW group (P＞0.05) before laparotomy.The levels of serum ET-1 increased and serum NO decreased after 30 min of blood flow opening in the transplanted intestine in both groups,more significantly in UW group.There was no significant difference in dry-wet ratio of small intestine before transplantation between the two groups (P＞ 0.05).When the blood flow was opened for 30 min,the dry wet ratio of small intestine in UW group was significantly lower than that in HMP group.There was no significant difference in blood flow velocity of intestinal microcirculation between the two groups before transplantation (P＞0.05),and the blood flow velocity of the two groups decreased significantly after 30 min of blood flow opening,more significant in UW group (P＜0.05).When the blood flow was opened for 30 min,there was mild edema of the lamina propria in the small intestinal tissue of the HMP group,scattered infiltration of the lymphocytes,no exuviation on the surface of the villi and no capillary congestion;In the small intestinal tissue of the UW group,there were edema and congestion of the intrinsic membrane,infiltration of the lymphocytes,the partial exuviation of the villi epithelial cells,focal erosion of the office,and capillary congestion.Conclusion Compared with cold preservation of UW solution,preservation of pig small intestine by HMP can reduce microvascular damage and alleviate the edema and injury caused by ischemia and hypoxia.
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Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation.Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.Ostomy of graft was performed instead of intestinal anastomosis during the operation.The anastomosis of graft and autologous intestine was performed 8 months after transplantation.Hospital and follow-up data of the patients were analyzed retrospectively.Result The functions of liver and small bowel recovered smoothly after operation.Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver.In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery.Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation.The patient was followed up for nearly 3 years with good quality of life without rejection and infection.Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen.
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Objective To summarize the main nursing point and experience of allogeneic small bowel transplantation.Methods One case underwent allogeneic small bowel transplantation in our hospital on the first of December 2010,the nursing measures were summarized.Results The patient passed the operation well-off,and survived the infection phase and repulsion phase in the transplantation ward.Conclusions Valid preoperative evaluation,taking active measures to prevent intraoperative hypothermia and infection,using self-made vacuum pads to prevent pressure sores during operation,are the guarantees for successful operation.
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Objective To establish two models of long-term chronic allograft rejection (CR)following orthotopic small bowel transplantation and compare the two models induced by cyclosporine A (CsA) or tacrolimus (Tac).Methods F344 and Lewis rats severed as donors and recipients,respectively.Transplantation was performed by anastomosing the graft superior mesenteric artery to the recipient infrarenal aorta and the graft portal vein to the recipient infrarenal inferior vena cava in an end-to side fashion.The recipients intestine was replaced with the graft by performing end-to-end small bowel anastomosis.In the study I,the rat was given intramuscularly CsA (5 mg · kg-1 · day-1) from postoperative day (POD) 0 to 13; In the study Ⅱ,the rat was given intramuscularly FK 506 at a dose of 0.3,0.5 and 1.0 mg· kg-1 · day-1 on POD 0-13,20,27,respectively.The body weight gain,survival rate and histology were observed.Results In the study I,there were significant changes of the CR histologically,including villous architecture,interstitial fibrosis,leukocyte infiltration,and obliterative arteriopathy.There was no significant difference in features of CR between POD 60 and POD 90,however,the serious villous blunting was not found; In the study II,the rats received Tac at dose of 0.3 and 0.5 mg·kg-1 ·day-1 and survived up to POD 126.The recipients received Tac at dose of 1.0 mg·kg-1 · day-1 and survived more than POD 180 and the body weight gain was the same as the isogenic groups.The histopathological analysis revealed distinctive features of CR including villous blunting.The characteristics of CR induced by CsA or Tac in the rat model of orthotopic small bowel transplantation could be demonstrated,however,the Tac-induced model was more closer to clinical small bowel transplantation pathology of CR.Conclusion Using the protocol of CsA or Tac,we developed a rat CR model of orthotopic small bowel transplantation,however,the Tac-induced recipients survived longer and had more classic characteristics of CR than CsA.
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Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of en bloc,the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.
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Objective Cytomegalovirus (CMV) has remained the most significant pathogen that threatens the outcome of small bowel transplantation (SBTx). This paper To outline preliminary experience of prophylaxis and treatment of cytomegalovirus (CMV) in 15 cases subject to small bowel transplantation (SBTx) and also review current progress of diagnosis and treatment of CMV.Methods Fifteen cases of SBTx were divided into 3 eras: era Ⅰ (1994-1995)-3 SBTx treated with cyclosporine-based immunosuppression; era Ⅱ (2003-2006)-7 SBTx treated with tacrolimus-based immunosuppression; and era Ⅲ (2007-present)-5 SBTx treated with Alemtuzumab induction therapy and maintenance tacrolimus monotherapy. No antiviral prophylaxis after SBTx was applied during era Ⅰ; in era Ⅱ, ileoscopic and pathological diagnosis of CMV graft enteritis was defined, and plasma diagnosis tools including CMV-IgM, CMV pp65 and CMV DNA with PCR were introduced. 2-3 weeks intravenous ganciclovir prophylaxis of CMV was underway, followed by 3 months oral acyclovir; In era Ⅲ, more precise real-time PCR technique was used to detect CMV DNA copies, and the schedule of the CMV surveillance was set up, antiviral prophylaxis therapy was modified to 2-3 weeks intravenous ganciclovir and 3 months oral ganciclovir, and preemptive therapy to halt the progression of asymptomatic infection to clinical disease was also introduced.Results Two of 15 SBTx recipients suffered from CMV with the occurrence rate of 13.3%. One recipient in era Ⅱ suffered from CMV graft enteritis on postoperative day 45, and CMV pneumonia on postoperative day 64, he received intravenous ganciclovir and thymus peptide, paused tacrolimus maintenance, and finally he died from severe acute cellular rejection. 94 100 copies/ml of CMV DNA in periphery blood of a recipient in era Ⅲ was detected with real-time PCR at 3rd month after SBTx, and a preemptive therapy successfully halted the CMV infection.Conclusion Antiviral prophylaxis therapy and close surveillance of CMV infection after SBTx should be performed, and preemptive therapy can also halt the CMV infection. When CMV disease occurs, the recipient should receive effective antiviral therapy, and acute cellular rejection also should be closely monitored at same time.
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Objective To evaluate the efficiency of monitoring parameters and methods of immunosuppresive treatment in intestinal transplantation and to provide scientific evidence for establishment of Intestinal Transplant Registry.Methods The data of 15 patients receiving intestinal transplantation between 1994 and 2009 were analyzed retrospectively for one year. The patients were fallen into 3 eras (1994-1995, 2003-2006, 2007-2009) according to different immunosuppresive strategies. The perioperative status and one-year survival rate were followed up. The monitoring frequency of implications of intestinal transplantation, such as rejection, infection, toxic and side-effects, was evaluated. The monitoring parameters were examined in the proportion of lymphocytes, concentration of tacrolimus, and function of the liver and kidney during a follow-up period of one year.Results During 1994-1995 and 2003-2006, the survival time of grafts was under one year. During 2007-2009, the 6-month and one-year survival rate in 5 patients (grafts) was 100% and 83.33% respectively; The increased frequency of rejection occurred during 7 to 12 months after operation; The closure of abdominal stoma was postponed from postoperative six months to one year; Asymptomatic mild rejection after operation was examined (10/13, 76.92%).Conclusion During one year postoperation, monitoring methods, parameters and frequency for immunosuppressive treatment in intestinal transplantation are rational, and may monitor the disease conditions of the patients.
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@#ObjectiveTo investigate the immune tolerance function and significance of allogene bone marrow injection to the small intestines transplantation of rats.MethodsInbreeding line rat F344/N and Wistar/A were selected to perform heterotopic graft of the whole small intestine. 7 days before allogene transplantation, donator bone marrow cells (BMC) were injected into thymus of acceptor (the testing group). According to the isogene and allogene rat transplant model, it was comprehended whether injecting allogene donator marrow into acceptor thymus could decrease the acute rejection after transplantation.Results3, 5 or 7 days after allogeneic rat dystopia whole small intestine transplantation, typical reject reaction appeared, but there was no reject reaction in isogenome and testing group. 3 days after allotransplantation, serum soluble interleukin-2 receptor (sIL-2R) and tumor necrotic factor-α (TNF-α) levels were significantly higher than the other groups (P<0.01). The level of serum sIL-2R and TNF-α in the allogene marrow injecting group were only slight higher on the 3rd or 5th day, and getting downtrend, and there was no significant difference compared with isogenic transplantation group.ConclusionAllogenic donator bone marrow intrathymic injecting into acceptor 7 days before small intestina transplantation, can reduce the reject reaction after the grafting. The levels of serum sIL-2R and TNF-α can be selected as a sensitive early diagnosis index of acute rejection after small intestine transplantation.
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Objective: To improve the limitation and stability of tissue processing on mucosa from small intestine transplantation and to provide better evidence of pathological diagnosis for the acute rejection on small intestine transplantation. Method:92 samples of mucosa from small intestine transplantation were reviewed.There were three methods of tissue processing (ultrasonic wave and microwave as well as routine) were adopted.The results were analyzed with statistical methods. Results: Among 18 samples processed by the method of ultrasonic wave,4 samples were A grade (22.22%). Among 50 samples processed by the method of microwave,30 samples were A grade (60.00%). Among 24 samples processed by the method of routine,13 samples were A grade (54.17%).The Chi Square Test suggested that there was statistic difference among three processing methods. Conclusions: Microwave is the best method of tissue processing on mucosa of small intestine transplantation and for the diagnosis acute rejection.
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Objective:To improve the surgical skill of Tri-cuff vascular anastomosis of the rat small intestinal transplantation. Methods:Artery anastomosis was done by employing the cuff anastomosis between a segment of donor abdominal aorta with superior mesenteric artery and recipient abdominal aorta.Venous anastomosis was done by employing the cuff anastomosis between dornor's vein and recipient's left renal vein.Results:The survival rate in 60 rats with small intestinal transplantation was 93.3%(56/60).Total operation time was about1.5～2h.The average times for the arterial anastomosis and venous anastomosis were (4?1)min and 1 min respectively.Conclusion:The modified skill of Tri-cuff vascular anastomosis for the orthotopic small bowel transplantation in rats speeds the vascular anastomosis and shortens the operation time,reduces the complications of the operation and improves the operation survival rate.
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Objective To report 2 cases of acute rejection following small intestin vivotransplantation and to disscuss the diagnostic significance of endoscopy and mucosal biopsy.Methods Endoscopic observation and mucosal biopsies of the graft through the terminal ileum enterostomy were carried out. Results Acute rejection was diagnosed in two patients with human small intestin vivotransplantation in good time.Endoscopic and the pathologic manifestations of the graft during acute rejection were discribed.Conclusion Endoscopy and the pathologic examination of endoscopically guided mucosal biopsy specimens are the most reliable method for diagnosing acute rejection following small intestin transplantation.