Research progress of allogeneic abdominal wall transplantation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice.@*METHODS@#The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications.@*CONCLUSION@#Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.

Polarization state and significance of macrophage in acute rejection after intestinal transplantation / 器官移植

Objective To investigate the changes of macrophage polarization during acute rejection (AR) after intestinal transplantation. Methods Six Brown Norway (BN) rats and 24 Lewis rats were divided into the sham operation group (6 Lewis rats), syngeneic transplantation group (Lewis→Lewis, 6 donors and 6 recipients) and allogeneic transplantation group (BN→Lewis, 6 donors and 6 recipients). At postoperative 7 d, the intestinal graft tissues in all groups were collected for hematoxylin-eosin (HE) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Pathological manifestations and cell apoptosis were observed. The expression levels of serum cytokines related to M1 and M2 macrophage polarization were determined by enzyme-linked immunosorbent assay (ELISA). Surface markers of M1 and M2 macrophages of intestinal graft tissues in each group were co-localized and counted by immunofluorescence staining. Results HE staining and TUNEL assay showed that the intestinal epithelial morphology and structure were normal and no evident apoptotic bodies were found in the sham operation and syngeneic transplantation groups. At 7 d after transplantation, the epithelial villi structure of intestinal graft tissues was severely damaged, the number of crypts was decreased, the number of apoptotic bodies was increased, and inflammatory cells infiltrated into the whole intestinal wall, manifested with moderate to severe AR in the allogeneic transplantation group. ELISA revealed that the expression levels of serum cytokines related to M1 macrophage polarization, such as tumor necrosis factor (TNF)-α, interferon (IFN)-γ and interleukin (IL)-12, of the recipient rats in the allogeneic transplantation group were higher than those in the sham operation and syngeneic transplantation groups. The expression levels of serum cytokines related to M2 macrophage polarization, such as IL-10 and transforming growth factor (TGF)-β, in the syngeneic transplantation group were higher compared with those in the sham operation and allogeneic transplantation group, and the differences were statistically significant (all P<0.05). Immunofluorescence staining showed that the number of M1 macrophages in the allogeneic transplantation group was higher than those in the sham operation and syngeneic transplantation groups, and the number of M2 macrophages in the syngeneic transplantation group was higher than those in the sham operation and allogeneic transplantation groups, and the differences were statistically significant (all P<0.05). Conclusions Among the allografts with AR after intestinal transplantation, a large number of macrophages, mainly M1 macrophages secreting a large number of pro-inflammatory cytokines, infiltrate into the whole intestinal wall. Regulating the direction of macrophage polarization is a potential treatment for AR after intestinal transplantation.

Diagnostic criteria and its progress on intestinal graft pathology / 器官移植

Intestinal transplantation has become the most ideal treatment for intestinal failure. Modern clinical intestinal transplantation includes three types: isolated intestinal transplantation, combined liver-intestinal transplantation and abdominal multivisceral transplantation. The immunological, anatomical and physiological characteristics of intestinal grafts significantly differ from those of other solid transplant organs. Consequently, intestinal grafts could develop specific and severe complications, such as acute rejection, chronic rejection, graft-versus-host disease (GVHD), infection and posttransplant lymphoproliferative disease (PTLD), among which acute rejection and infection are extremely challenging. Endoscopic examination and intestinal mucosal biopsy of intestinal grafts could be performed to make timely diagnosis and differentiation of these complications, then deliver targeted treatment and guarantee the long-term survival of recipients and intestinal grafts.

Short Bowel Syndrome as the Leading Cause of Intestinal Failure in Early Life: Some Insights into the Management / 대한소아소화기영양학회지

Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting “nutritional failure” which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.

Acellular dermal matrix prevents intra-abdominal hypertension for abdominal wall closure following small bowel transplantation: A case report / 中华器官移植杂志

Objective To investigate the effect of acellular dermal matrix (ADM) for abdominal closure to prevent abdominal high pressure after intestinal transplantation.Method ADM was used for abdominal closure following intestinal transplantation in a 17-year-old man with ultra-short bowel syndrome.Two ADMs with 12 cm 20 cm were reconstituted intraoperatively with warm sterile normal saline.After flattened under peritoneum,the ADM was pruned and then sewn to the muscular layer of abdominal wall by interrupted transfixing suture with absorbable suture.A negative pressure drainage tube was placed over an area of native fascia in the subcutaneous space.Skin and soft tissues were closed by interrupted suture.Result The intra-abdominal pressure was not higher than 7 cmH2O 90 h post-operation.The ventilator has been withdrawn 18 h after operation.Enternal nutrition was given from postoperative day 6.He required surgical exploration for abdominal abscess on the postoperative day 19.The ADM closely adhered to the abdominal wall and no abscess in abdomen was related to ADM.Conclusion ADM can be safely used for abdominal closure and effectively prevent intraabdominal high pressure in this intestinal transplantation.No infection or graft loss occurred in the early postoperative period.More observations are needed to study the long-term results and complications in the future.

Study on effects of curcumin pretreatment on intestinal ischemia-reperfusion injury / 器官移植

Objective To explore the effects and mechanism of curcumin pretreatment on intestinal ischemia-reperfusion injury (IRI)in rats.Methods Thirty SD rats were randomly divided into sham operation group (Sham group),IRI group and curcumin pretreatment group (Cur group),with 1 0 rats in each group.Intraperitoneal injection with curcumin (5 mg/kg)was given to rats in Cur group at 1 h before operation;intraperitoneal injection with normal saline of same volume was given to rats in Sham group and IRI group.Rats in IRI group and Cur group received intestinal IRI operation.Pathological changes in intestinal tissues of the rats in 3 groups were observed.Messenger RNA (mRNA)levels of interleukin (IL)-6,IL-8 and tumor necrosis factor (TNF)-αin intestinal tissue were detected by reverse transcription polymerase chain reaction,and protein expression levels of IL-6,IL-8 and TNF-αin serum were detected by enzyme linked immunosorbent assay (ELISA).Malondialdehyde (MDA)in intestinal tissue was detected by thiobarbituric acid reactive substance assay,as well as contents of catalase (CAT),glutathione peroxidase (GPx)and superoxide dismutase (SOD) in intestinal tissue were detected by ELISA.Protein expression levels of phosphatidylinositol 3-kinase (PI3K),protein kinase (AKT)and mammalian target of rapamycin (mTOR)in intestinal tissue were detected by Western blotting.Results Compared with Sham group,the injury degree of intestinal tissue as well as the expression levels of IL-6,IL-8,TNF-α, MDA,PI3K,AKT and mTOR in intestinal tissue and serum increased significantly,while the contents of CAT,GPx and SOD in intestinal tissue decreased significantly in IRI group.Compared with IRI group,the injury degree of intestinal tissue as well as the expression levels of IL-6,IL-8,TNF-α,MDA,PI3K,AKT and mTOR in intestinal tissue and serum decreased significantly,while the contents of CAT,GPx and SOD in intestinal tissue increased significantly in Cur group (all in P <0.05).Conclusions Curcumin presents protective effect on intestinal tissue with IRI in rats,which may be related to the inhibition of oxidative stress and inflammation mediated by PI3K/AKT/mTOR signaling pathway.

Manufacture and comparison of chronic rejection model of orthotopic and heterotopic intestinal ;transplantation in rats / 器官移植

Objective To compare the modeling effect of chronic rejection following orthotopic and heterotopic intestinal transplantation in rats.Methods F344 (RT1 1 vr )rats were used as the donors and Lewis (RT1 1 )rats were used as the recipients.Models of allogeneic heterotopic and orthotopic intestinal transplantation in rats (8 rats in each model) were established,and subcutaneous injection of ciclosporin was given at 0 ~1 4 d after operation.Changes in body weight and survival time of the recipients were observed after operation.In addition,pathological changes in intestinal tissue were observed by hematoxylin-eosin (HE)staining.Changes in collagenous fibers and elastic fibers in intestinal tissue were observed after alcohol and hematoxylin staining.Finally,success rate of modeling of recipients in two groups was calculated.Results Rats in heterotopic and orthotopic intestinal transplantation groups were able to survive for a long time,most of which were more than 90 d.For the rats in orthotopic intestinal transplantation group,normal diet could be recovered at the 3 rd d after operation.Their body weight could recover preoperative level at about the 1 4th d after operation,and then grew slowly.However,most of the rats in orthotopic intestinal transplantation group continued weight loss from the 1 50th d after operation,which could not be reversed with ciclosporin.For the rats in heterotopic intestinal transplantation group,normal diet could be recovered at the 1 st d after operation,and their body weight could recover preoperative level within 25-30 d after operation and gradually rose and remained at a high level within 30-90 d after operation.No pathological changes of chronic rejection and obvious mesangial fibrosis in intestinal tissue were observed at the 90th d after operation,but intestinal tissue developed chronic rejection and obvious mesangial fibrosis at the 1 63 rd d and 200th d after operation in orthotopic intestinal transplantation group.Typical pathological changes of chronic rejection and mesangial fibrosis in intestinal tissue were observed at the 90th d and 200th d after operation for rats in heterotopic intestinal transplantation group.All the rats in heterotopic intestinal transplantation group showed characteristic pathological changes.The success rate of modeling was 1 00% in heterotopic intestinal transplantation group,which was not of statistical significance,compared with the success rate of modeling of 75% in the orthotopic intestinal transplantation group (P >0.05).Conclusions Chronic rejection will occur at different time points with small dose of ciclosporin after operation if models of orthotopic and heterotopic intestinal transplantation are established in combination of F344 → Lewis rats.Compared with orthotopic intestinal transplantation,the rat model of heterotopic intestinal transplantation holds the advantages of simple modeling,shorter chronic rejection and relatively consistent degree of pathological changes,which is more suitable for experimental study.

Comparative study on the preservation quality of intestinal grafts from donors of donation after cardiac ;death and cadaveric donors / 器官移植

Objective To compare the preservation quality of intestinal grafts from donors of donation after cardiac death (DCD)and cadaveric donors.Methods Quality of intestinal grafts from 7 cadaveric donors (group N)and 7 DCD donors (group DCD)in Beijing from 201 3 to 201 4 was evaluated.The grafts were preserved after perfusion and resection,and then intestinal tissue was collected 30 min and 6 h later.Meanwhile,histopathological examination and intestinal graft injury score (Chiu's integral method)were performed.The content of malondialdehyde (MDA)in intestinal tissue was detected by thiobarbituric acid assay,and the apoptosis of intestinal mucosa cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)method.Results Intestinal graft injury scores for group N and DCD were (1 .46 ±0.81 )and (1 .76 ±0.21 )respectively at 30 min after preservation,and (3.86 ± 0.42)and(4.1 7 ±0.71 ),respectively at 6 h after preservation(both in P >0.05).Compared with the preservation of 30 min,intestinal graft injury scores increased significantly in both groups at 6 h after preservation (both in P <0.05).The contents of MDA in intestinal tissue of the small intestinal graft in group N and DCD were (1 00 ±1 0)pmol/mg and (1 1 0 ±1 3)pmol/mg,respectively at 30 min after preservation (P >0.05),and (1 70 ±1 8)pmol/mg and (31 0 ±29) pmol /mg,respectively at 6 h after preservation,of which the difference was statistically significant between the two groups at the same time (P <0.05).Compared with the preservation of 30 min,the contents of MDA increased significantly in both groups at 6 h after preservation (both in P <0.05 ).The number of apoptotic intestinal mucosal cells in small intestinal grafts for group N and DCD was (9.78 ±2.56)and (1 5.78 ±2.84),respectively at 30 min after preservation (P >0.05),and (31 .32 ±1 .38)and (53.42 ±1 .95),respectively at 6 h after preservation,of which the difference was statistically significant between the two groups (P <0.05).Compared with the preservation of 30 min,the number of apoptotic intestinal mucosal cells in small intestinal grafts increased significantly in both groups at 6 h after preservation (P <0.05).Conclusions Preservation quality of small intestinal grafts in DCD donors is roughly equivalent to that in traditional cadaveric donors,which suggests that small intestinal grafts in DCD donors may be used in clinical intestinal transplantation.

Clinical efficiency of monoclonal antibody induction therapy in intestinal transplantation / 中华器官移植杂志

Objective To evaluate the clinical efficiency of humanized anti-CD52 monoclonal antibody (Campath-1H) and anti-CD25 monoclonal antibody (Zenapax) induction therapy in intestinal transplantation patients.Method The data of 6 patients receiving Campath-1H and 5 patients receving Zenapax induction therapy in intestinal transplantation between 2007 and 2012 were analyzed retrospectively.The counts of peripheral blood lymphocytes and monocytes,incidence of rejection and infention,and liver and kidney toxicity of recipients were recorded before and 3 months after transplantation.Results Of 6 intestinal transplantation patients receiving Campath-1H induction therapy,1 died of acute heart failure on the postoperative day 3,and the rest 5 patients had a powerful depletion of lymphocytes and monocytes in 8 weeks,followed by gradual increases after 8 weeks.The percentage of peripheral blood CD3 + T cells,CD4 + T cells,and CD8 + T cells was dropped to 5％ before administration,and remained at a steady low level in the first 8 weeks after induction.Of 5 patients receiving Zenapax induction therapy,1 died of Aspergillus infection on the postoperative day 25,and the rest 4 patients had an obeivous increase of lymphocytes and monocytes on the postoperative day 1.Counts of lymphocytes and monocytes kept steady at normal levels from the 1st to 12th week.One case of mild rejection was found in Campath-1H group.One case of mild,one moderate and one severe rejection were detected in Zenapax group.All rejections were successfully cured by prompt anti-rejection therapy.There were no significant difference in serum creatimine,urea nitrogen,alanine aminotransferase or total bilirubin after 3 months in comparison to preoperation.Conclusion Both Campath-1H induction therapy and Zenapax induction therapy successfully induce immune tolerance in patients with intestinal transplantation.Campath-1H seems to offer better immunosuppression against Zenapax during the first 3 months posttransplantation.

Modified orthotopic segmental small bowel transplantation in rats / 中华消化外科杂志

Objective To establish a simple and stable orthotopic segmental small bowel transplantation model in rats.Methods Eighty male SD rats were divided into donors and recipients.Orthotopic segmental small bowel transplantation was performed by end-to-side anastomosis between donor abdominal aorta tundish-shape patch with arteria mesenterica superior pedicle and abdominal aorta of the recipients; end-to-end anastomosis between the portal vein of the donors and the left renal vein of the recipients was done using the cuff technique ; the large part of the small bowel of the recipients was excised,and it was replaced by the segmental intestine of the donors.Results The operation time of the donors and recipients were (40 ± 5) minutes and (50 ±8)minutes,respectively.The warm ischemia time and cold ischemia time were (5 ± 2) minutes and (15 ± 5) minutes,respectively.The anastomosis time of arteries and veins were (5 ± 2) minutes and (4 ± 2) minutes,respectively.The survival time of 90.0％ (36/40) of rats was more than 10 days.Conclusion The modified rat model of orthotopic segmental small bowel transplantation is easy to manipulate,and has the advantages of short operation time,high survival rate and stability.

The nitric oxide in ischemia-reperfusion injury and acute rejection of rat intestinal transplantation / 中华器官移植杂志

ObjectiveTo evaluate the role of nitric oxide (NO) in ischemia reperfusion injury (IRI) and acute rejection (AR) of intestinal transplantation in rats.MethodsThe rat orthotopic intestinal transplantation was performed. Animals were assigned to the following 4 groups with random methods:transplant control group,L-arginine (L-Arg) group,NG-Nitro-L-arginine methyl ester (L-NAME) Ⅰ group (group Ⅰ ) and L-NAME Ⅱ group (group Ⅱ ).The rats in different group were given saline,L-Arg (150 mg· kg-1 · d-1 ),L-NAME (4 and 8 mg· kg-1 · d-1 ) injection respectively from the operative day.The recipient survival time was observed.The pathologic changes were observed by HE staining.The activity of nitric oxide synthases (NOS) was measured by using immunohistochemistry.The abilities of glucose absorption and serum NO levels were tested.Results The recipient survival timein transplant control group,L-Arg group,group Ⅰ and group Ⅱ were (11.7 ± 1.2),(10.2 ± 1.0),( 12.3 ± 1.5) and ( 17.3 ± 1.9) days respectively,and the survival in group Ⅱ was prolonged significantly (P＜0.01).As compared with control group,the Park scores in L-Arg group and group Ⅰ were reduced,and IRI were attenuated; the Park score in group Ⅱ was increased (P＜0.01),the IRI was aggravated,but the AR was attenuated.As compared with control group,during the IRI period,the iNOS staining in group Ⅰ was decreased,and both iNOS and nNOS staining in group Ⅱ was decreased; during the AR period,the iNOS staining in group Ⅱ was decreased obviously.The serum NO levels were increased gradually in all groups.As compared with control group,the increase of serum NO level in group Ⅱ was delayed.As compared with control group,the glucose absorption levels in L-Arg group were increased significantly from 30 min after reperfusion to POD-3 (P＜0.01),and the postoperative glucose absorption levels in groups Ⅰ and Ⅱ maintained the low levels.ConclusionNO may play a dual role as both cytotoxic and cytoprotective effects in IRI,and aggravate mucosal damage in AR in rats intestinal transplantation.The glucose absorptive capacity of graft is promoted by supplementation of LArg at early postoperative period.

Current Status of Intestinal Failure and Intestinal Transplantation / 대한소아소화기영양학회지

Pediatric intestinal failure occurs secondary to short bowel syndrome, motility disorders, or malabsorption. The establishment of an intestinal rehabilitation program and the introduction of innovative surgical and medical treatments, such as the serial transverse enteroplasty procedure and omega-3-containing lipid emulsions, have been major advances in the treatment of intestinal failure. Intestinal transplantation is now established as a therapeutic modality in selected children with irreversible intestinal failure. The improved short to intermediate term survival of intestinal transplant recipients in the last decade can be attributed to immunosuppression with a lymphocyte-depleting agent, control of acute cellular rejection, and comprehensive infection control with careful monitoring of viral pathogens including cytomegalovirus and Epstein-Barr virus.

Liver graft induces the immune tolerance of intestinal allograft in auxiliary en-bloc Hver-small bowel transplantation in pigs / 中华消化外科杂志

Objective To study the effects of liver graft on the immune tolerance of intestinal allograft in auxiliary en-bloc liver-small bowel transplantation in pigs.Methods Seventy outbreed Landrace pigs were divided into 4 groups.Ten auxiliary liver-small bowel allotransplantations were performed in group A,B,C,respectively,and 5 segmental small bowel allotransplantatiom were performed in group D.Pigs were administered with routine and lower dose of cyclosporine and methylprednisolone in group B and C,respectively. No immunosuppressive agent was administered to pigs in group A and D.Results The initial time of acute rejection was obviously prolonged in group A than group D.and the acute rejection was milder in group A than group D(P＜0.05).There was no significant difference upon postoperative survival time,initial time of acute rejection and degree of acute rejection between group B and C(P＞0.05).Conclusions The immune tolerance of intestinal allograft Can be induced by liver graft in auxiliary en-bloc liver-small howel transplantation.

Overview of short bowel syndrome and intestinal transplantation / Actualización sobre síndrome de intestino corto y transplante intestinal

Short bowel syndrome is at once a surgical, medical, and a disorder, with potential for life-threatening complications as well as eventual independence from artificial nutrition. Navigating through the diagnostic and therapeutic decisions is ideally accomplished by a multidisciplinary team comprised of nutrition, pharmacy, social work, medicine, and surgery. Early identification of patients at risk for long-term PN-dependency is the first step towards avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis and treatment of infections such as line sepsis, and bacterial overgrowth can significantly improve prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are suffering from serious complications related to TPN administration.

El síndrome de intestino corto es una entidad médico-quirúrgico, con potencial riesgo para poner en peligro la vida de los niños, y que en su manejo incluye nutrición artificial. El estudio diagnóstico y terapéutico se logra idealmente con un equipo multidisciplinario compuesto de nutricionista, químico, trabajadora social, médico y cirujano. Uno de los primeros pasos, es la identificación anticipada de pacientes a riesgo de presentar complicaciones severas por el uso prolongado de nutrición parenteral. Su pronóstico se mejora con la estrecha supervisión del estado nutricional, por la introducción temprana de la nutrición enteral y la prevención a tiempo en el diagnóstico y tratamiento de infecciones bien de la línea arterial, o por sobrecrecimiento bacteriano. El transplante intestinal emerge como parte del tratamiento que puede ser considerado cuando la falla intestinal es irreversible y en los niños que presentan complicaciones serias relacionadas con la administración de nutrición parenteral.

Advances of Abdominal Multivisceral Transplantation / 上海第二医科大学学报

Abdominal multivisceral transplantation is a new and proved effective therapeutic methods for two or more terminal abdominal organs. Upper abdominal exenteration(resection of the liver,stomach,spleen,pancreaticoduodenal complex,and part of the colon) for the treatment of otherwise unresectable tumors is one of the more radical operations in oncology.Some new surgical methods such as liver-intestinal,liver-kidney,pancreas-kidney and multivisceral cluster transplantation have emerged recently.These new advance surgical approache improve the curative effect of abdominal organ transplantation.

Liver disease associated with intestinal failure in the small bowel syndrome / Doença hepática associada à falência intestinal na síndrome do intestino curto

The introduction of the Total Parenteral Nutrition (TPN) has given rise to a new hope in the treatment of intestinal failure (LF) associated with the Short Bowel Syndrome (SBS). However, together with the TPN and the increase of survival of these patients, new problems and questions have emerged, as well as new therapeutical procedures. Taking into consideration this emerging reality, this paper has the purpose to undertake a review of current concepts and available treatments for patients with IF associated-liver disease. Although TPN provides an increase of survival of patients with intestinal failure, it is a potential source of complication such as: septicemia, hyperglycemia, venous thrombosis and liver disease. There are several hypothesis conceived to explain the liver disease associated to intestinal failure, however the only definite treatment as a potential to reverse the non-cirrhotic liver disease is the small intestine transplantation. Despite indications for intestine transplantation are not entirely defined in literature, the trend is its early indication in high-risk patients, preserving the liver integrity and preventing the eventual need of both liver and intestine transplantations altogether.

A introdução da Nutrição Parenteral Total (NPT) despertou uma nova esperança para o tratamento da falência intestina (FI) associada a Síndrome do Intestino Curto (SIC). No entanto, junto com a NPT e o aumento da sobrevida destes pacientes, novos problemas e perguntas emergiram, assim como novas terapêuticas. Tendo em vista esta realidade emergente, o intuito deste artigo é realizar uma revisão dos conceitos atuais e dos tratamentos disponíveis para pacientes com doença hepática associada a FI. A NPT apesar de proporcionar aumento da sobrevida nos pacientes com falência intestinal é fonte potencial de complicações, como: septicemia, hiperglicemia, trombose venosa e doença hepática. Diversas são as hipóteses aventadas para explicar a doença hepática associada a falência intestinal, no entanto, o único tratamento definitivo, com potencial para reverter à doença hepática não cirrótica, é o transplante de intestino delgado. Apesar das indicações do transplante de intestino não estarem totalmente definidas na literatura, a tendência é indicá-lo precocemente em pacientes de alto risco, preservando a integridade hepática e prevenindo a eventual necessidade de transplante de fígado e intestino combinados.

Effects of p38 Mitogen-Activated Protein Kinase on Apoptosis of Small Intestinal Epithelial Cells after Transplantation in Rats / 中国普外基础与临床杂志

Objective To explore the effects of p38 mitogen-activated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. Methods Small intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Western-blotting method and serum TNF-? was determined by ELISA. Results Mild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups (P0.05). The expression of p38 MAPK and the level of serum TNF-? were positively correlated with apoptosis in small intestinal rejection after transplantation (r=0.875, P

Intestinal and Multivisceral Transplantation

Intestinal transplantation has been established as a treatment option for patients that suffer from intestinal failure with complications from total parenteral nutrition. It is still rapidly evolving and just reached a landmark of 1, 000 cases worldwide. Intestinal allografts can be transplanted as isolated, combined with the liver or as a part of a multivisceral allograft. Tacrolimus-based immunosuppression regimens have been used universally with improved outcomes. Clinical outcome in intestinal transplantation has improved significantly over time, impacted by refinement of surgical technique and novel immunosuppression. However rejection, infection, and technical complications still remain the most difficult barrier to improve patient and graft survival.

Intestinal transplantation: history and technique

Because of fail of the first 7 cases of the intestinal transplantation in 1964, the intestinal transplantation was not regarded. Until 1985, the intestinal transplantation has been returned applied. The technique includes 2 phases: the collection and preservation of the intestine from donor and transplantation of this intestine. The resource of the intestine can be the intestine of someone that his (her) brain was dead or of the healthy people. The technique comprises the vascular transplantation and the establishment of the digestive system.

Short Bowel Syndrome Due to Infarction of the Superior Mesenteric Artery

The syndrome of mesenteric ischemia remains clinically challenging despite decades of surgical experience, and occlusive disease involving the arteries to the viscera is associated with the life-threatening complications of intestinal infarction. Total parenteral nutrition has been shown to be an excellent treatment modality that has allowed many patients with intestinal failure to survive with a reasonable quality of life. However, only with the development of successful intestinal transplantation of the gut will the short bowel syndrome be cured. If intestinal transplantation could be performed with acceptable morbidity and mortality rates, it would offer a more physiologic and economic approach to the problem of short bowel syndrome. We report a case of short bowel syndrome due to infarction of the superior mesenteric artery along with a review of the literature.