RESUMEN
Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.
Asunto(s)
Humanos , Infecciones por VIH/cirugía , Trasplante de Órganos/normas , Hospitales Universitarios/normas , Brasil , Selección de Paciente , Receptores de TrasplantesRESUMEN
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.
RESUMEN
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.
RESUMEN
Objective To investigate the changes of expression of apoptosis-related proteins Bcl-2,Bax and Fas of the transplantated hepatocytes after intraperitoneal transplantation in rats using porcine hepatocytes cultured with polylactic acid-O-carboxymethylated chitosan nanoparticles.Methods Recirculating collagenase perfusion method was used to isolate porcine hepatocytes.At 48h after D-galactosamine intraperitoneal injection,5 mL polylactic acid-O-carboxymethylated chitosan nanoparticles-cultured porcine hepatocytes embedded in collagen gel(group A) and 5 mL porcine hepatocytes embedded in collagen gel(group B) were transplanted into peritoneal cavity of SD rats,respectively.The amount of transplanted porcine hepatocytes was 5.0?107 hepatocytes in two groups.The expression of Bcl-2,Bax and Fas in transplanted hepatocytes three days after transplantation was detected with immunohistochemistry.Results At 1,2 and 3d after transplantation,the rates of Bcl-2 positive cells in group A was significant higher than those in group B,whereas the rates of Bax and Fas positive cells in group A were significant lower than those in group B(P
RESUMEN
Objective To study the protective effects of the heat shock protein 70(HSP70)induced by zinc sulfate on reperfusion injury following pancreaticoduodenal transplantation in rats.Methods The homologous male Wistar rat model of heterotopic total pancreaticoduodenal transplantation was used.The ZnSO4 treated rats received the intravenous injection of Zn2+5 mins before and after operation at a dose of 5 mg/kg(Zn-1 group),10 mg/kg(Zn-2 group) and 15 mg/kg(Zn-3 group),and the control group with the same volume of saline.The tissue concentration of HSP70 was determined using Western-Blot.In addition,blood sugar(BG) and serum concentration of amylase and lipase were examined 24h after transplantation,and the activity of myeloperoxidase(MPO) in the pancrease graft was measured at the same time.Histological observation was performed.Results Light microscopic studies showed that histomorphological changes of pancreas in Zn-2 group and Zn-1 group were much less than those in control group and Zn-3 group.The value of BG and serum lipase and MPO in Zn-2 group
RESUMEN
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.
RESUMEN
Objective To determine the changes of gene expression profile in small intestinal allograft in rats after cold preservation/reperfusion and investigate the mechanism of allograft injury. Methods Heterotopic segmental small bowel transplantation in rats was performed with a modified technique. Total RNAs was extracted from the allografts (experimental group) and normal intestines (control group) 1h after cold preservation /reperfusion, and then purified to mRNA. Equal mRNAs of the two groups were as 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 4096 target genes, 82 differentially expressed genes were identified between the two groups. There were 18 novel genes and 33 expression sequence tags. 31 genes reported and differentially expressed could be related to the preservation/reperfusion injury of grafts. Conclusions Abnormal adhesion between polymorphonuclear cells and microvascular endothelial cells, and failure in energy, glucose and protein metabolism of grafts may contribute to cold preservation/reperfusion injury of small intestinal allografts.
RESUMEN
Objective To investigate the features and significance of pathologic changes in apoptosis of small bowel allograft during acute rejection in rats. Methods All 24 recipients were equally divided into four groups ; group A: nonoperative control; group B: allograft ; group C: isograft, group D: treatment control. The graft samples were harvested on day 3, 5, 7, 10 after transplantation, and subjected to histologic examination . Mucosal thickness, villous height and crypt depth were measured, and apoptotic cells of intestinal mucosa of grafts on day 3,5 and 7 after transplantation were examined. Results The mucosal structure was normal in group A; The degree of the inflammatory infiltrated cells ,intestinal mucosa cell apoptosis and structural injury of mucosa in group B were significantly severe compared with groups C and D. As the post-transplanted time increased, the number of musocal apoptotic cells and the degree of mucosal structural injury were significantly increased. The degree of mucosal structural injury in group C was milder than in group B. A few infiltrated cells and mild edema of mucosa occurred in group D , but no mucosal structural injury was found. Conclusions Inflammatory cell infiltration, mucosal epithelial cell apoptosis and mucosal structural damage are the main pathologic features of small bowel allograft during acute rejection. Dynamic observation of the pathologic changes and cell apoptosis of small bowel graft is of certain value in the diagnosis of acute rejection of small bowel graft and in assessment of the degree of small bowel injury.
RESUMEN
Infracaput fracture of collum femoris in the youth is usually caused by tremendous violenceand characterized by obvious translocation and high ratio of ischemic necmeis of femoral head. Artificialfemoral head replacement or hip replacement is not suitable for the youth. Twenty-eight cases of suchfracture were treated with implantation of quadrate muscle of thigh with bone flap combined with internalfixation by screw,and a follow-up Period of 8 ~ 36 months was carried on. The results showed that allcases resulted in a bony union and ischemic necrosis of femoral head did not occur.It is suggested thatthe opelation should be Performed as early as possible to restore the blood circulation of femoral head,and proper reduction and firm internal fixation guarantee the union of fracture,Quadrate muscle of thighwith bone flap has a rich blood supply and operation can be accomplished in the same incision of internalfixation,so that the injury is iess and the successful rate is high.
RESUMEN
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.
RESUMEN
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.
RESUMEN
0.05), but in Wistar→SD group and Wistar→SD+CsA group, the serum IL-1? (levels) (increased) as the number of apoptotic cells increased(P
RESUMEN
Objective To study the depressant effect of atorvastatin on arteriosclerosis of aortic allograft in rats.Methods The models of abdominal aorta transplantation were established in rats with the use of(micro-surgery).The recipients were divided into three groups:allograft control group,allograft experimental group and isograft control group.After 60 days of transplant,vascular intimal thickness(VIT) in all of the groups was observed by histological examination.The expression of PCNA and ?-SMA was determined by(immunohistochemistry).Results The degree of VIT in rats of the allograft experimental group was lower than that in the allograft control group;the VIT area ratio in the allograft control group,allograft experimental group and isograft control group was(12.40?2.65)%,(5.20?6.35)%,and(1.2?1.10)%,respectively,A statistical difference between these groups was observed(P
RESUMEN
Objective To investigate the effect of early inflamation on the efficacy of gene(LacZ gene)(transfer) to vein graft by adenovirus vector.Methods The liquid containing adenovirus vector was infused through external carotid vein and the segment of carotid vein was resected.The veins were inflated naturally.After 30min incubation,the veins were transplanted into carotid artery in experimental group,and the(circulation) was restored in control group.The veins with transferred gene were collected on day 3,day 14 and day 21.The mark gene expression in the veins was studied with X-Gal stain and activities of ?-galactase were measured.ICAM-1 and VCAM-1 expressions were observed by immunohistochemistry stain in transgenic veins.Results The activities of ?-galactase in mark gene expressed for 14 days was decreased and in 21 day nearly disappearred.VCAM-1 and ICAM-1 expression upregulated after day 3 in transplanted veins and there was leucocyte infiltration and shedding of endothelial cells with endothelial disruption.On the other hand,there was no expression of VCAM-1 and ICAM-1 in control group veins and integrity of endothelium was intact.The positive ECs expressed mark gene was obviously reduced in transplanted veins compared to control group.But the number of positive SMCs were not significently different between to two groups.(Conclusions) The inflammation of vein grafts in early stage of transplantation may be the cause of(endotheliocyte) damage and is related to rapid depression of gene expression.
RESUMEN
Objective Dynamical observation the development law of rejection of small intestinal transplantation(SIT) in inbred rats BN to F334,to study the value of this SIT madel in the rsesarch of rejection. Methods Heterotopic SIT models were established by microsurgical technique according to modified monchik method in inbred strain F344/RT1 l andBN/RT1 n,including isotransplantation (F344→F344, n =8 ,ITx group) and allotransplantation (BN→F344, n =8, ATx group). Results (1) The mean survival time was over 30 days in AT X group, 12 days in IT X group(P
RESUMEN
ObjectiveTo investigate the expression and significance of p38 mitogen-activated protei n kinase (MAPK) in autogenous vein graft. Methods Autogenous vein graft model was established by transplanting the right jugular vein to infr arenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after s urgery,respectively. Reverse transcription-PCR and in situ hybridization,Wester n blot and immunohistochemistry methods were used to detect the expression of pr otein and phosphorylation protein of p38 and p38mRNA. ResultsThe expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%?26%),and significantly higher than that on 4,6,8 weeks( P
RESUMEN
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.