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Bowel Transplantation (bowel + transplantation)
Kinds of Bowel Transplantation Selected AbstractsAn Innovative Sphincter Preserving Pull-Through Technique with En Bloc Colon and Small Bowel TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2010K. R. Eid This report describes a new innovative pull-through technique of hindgut reconstruction with en bloc small bowel and colon transplantation in a Crohn's disease patient with irreversible intestinal failure. The approach was intersphincteric and the anastomosis was established between the allograft colon and the recipient anal verge with achievement of full nutritional autonomy and anal continence. [source] Effects of extrinsic denervation on innervation with VIP and substance P in circular muscle of rat jejunum,NEUROGASTROENTEROLOGY & MOTILITY, Issue 7 2008M. S. Kasparek Abstract, Extrinsic denervation contributes to enteric motor dysfunction after small bowel transplantation (SBT). Our aim was to determine changes in nonadrenergic, noncholinergic innervation with vasoactive intestinal polypeptide (VIP) and substance P (Sub P) in rat jejunal circular muscle after SBT. Muscle strips were studied in tissue chambers from six groups of rats (n , 6 per group): naïve controls (NC), animals 1 week after anaesthesia/sham celiotomy (SC-1), and 1 and 8 weeks after jejunal and ileal transection/reanastomosis (TA-1, TA-8) and after syngeneic, orthotopic SBT (SBT-1, SBT-8). Response to exogenous VIP and Sub P and their endogenous release during electrical field stimulation (EFS) were studied. Exogenous VIP and Sub P caused a dose-dependent inhibition and stimulation of mechanical activity in all groups respectively (P < 0.05). The responses to VIP and Sub P were decreased (compared to NC) in all groups at 1 and 8 weeks postoperatively. The VIP antagonist ([d - p -Cl-Phe6,Leu17]-VIP) did not prevent the inhibition by exogenous VIP in any group, while the Sub P antagonist ([d -Pro2,d -Trp7,9]-Sub P) prevented the effect of exogenous Sub P in NC, TA-8 and SBT-8 (P < 0.05). Responses to exogenous VIP were unaffected by the nitric oxide synthase inhibitor l - NG -nitro arginine and precontraction of muscle strips with Sub P. Endogenous release of VIP and Sub P during EFS was preserved after SBT. In circular muscle of rat jejunum, changes in neuromuscular transmission with VIP and Sub P during the first 8 weeks after SBT are not mediated by extrinsic denervation. [source] Features of chronic allograft rejection on rat small intestine transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2007Hao Ma Abstract:, The aim of this study was to develop a model of chronic rejection of the entire small intestine transplantation and to analyze the features of chronic rejection. Allogenic small bowel transplantation was performed in a rat combination of Lewis to F344. Intestines were procured at the 60th and the 90th day after operation. We compared the semiquantitative score of histological parameters. The immunological components involved in the chronic rejection process were evaluated by immunohistochemical staining and the cytokine levels in grafts. The significant characteristics of the allograft on histology were changes of villous architecture, interstitial fibrosis, leukocyte infiltration, and obliterative arteriopathy. Allografts on the 60th day post-transplantation had more score in inflammatory events, while the grafts on the 90th day after operation had more values in ischemia/fibrotic events. The number of infiltrating CD4, CD8 and macrophage cells in allografts progressively decreased over time. The level of intrgraft cytokines such as IL-6, TNF- , and IL-10 in the 90th day after transplantation also decreased compared with that in the 60th day. These data suggested that in the early stage (POD 60), there were more active and intense inflammatory events; later (POD 90) allografts manifested less inflammation and more arterial obliteration and fibrosis. [source] Pattern of growth after pediatric living-donor small bowel transplantationPEDIATRIC TRANSPLANTATION, Issue 6 2006Marian Porubsky Abstract:, The aim of our study was to analyze growth in children who underwent LDSB. The question was whether these children obtain linear growth and improvement of the Z-score for height and weight after the transplant. Three children with a mean age of 24 months underwent living-donor intestinal transplantation with 150 cm of terminal ileum. At a mean follow-up of 27 months height increased from 82.5 to 97.5 cm although Z-score for height did not improve, ,2.679 to ,2.675. Mean weight increased from 11.4 to 14.2 kg while Z-score for weight went from ,1.916 to ,2.409. Although these data are pertinent to only three children and the follow-up is slightly longer than two yr, it appears that while long-term survival and independency from TPN is achieved, only linear growth might be expected and catch-up growth does not occur. [source] EBV-negative lymphoproliferative disease with hyper-IgA, in a child with combined liver and small bowel transplantationPEDIATRIC TRANSPLANTATION, Issue 3 2004Clotilde Des Robert Abstract:, A 4-year-old boy presented 14 months after liver and small bowel transplantation with fever, diarrhea, elevated liver enzymes, thrombocytopenia and autoantibodies. Total gammaglobulins level was normal but the level of plasma IgA1 was very high. The blood PCR for Epstein,Barr virus (EBV) was negative. The ileal biopsy disclosed a lymphoplasmacytic infiltration. The EBER probe was negative on the small bowel biopsies. The child was considered as suffering from a non-EBV-induced posttransplant lymphoproliferative disorder (PTLD). The high IgA level was presumed to be secreted by proliferating plasma cells in the transplanted bowel. Immunosuppression was reduced; but the efficacy was incomplete and an anti-CD20 antibody was added. There was complete resolution of symptoms and normalization of the IgA level. As IgA1 is mostly of intestinal origin, this unusual presentation of PTLD should lead to a high suspicion of a small bowel proliferating process. [source] Living related small bowel transplantation in children: 3-dimensional computed tomography donor evaluationPEDIATRIC TRANSPLANTATION, Issue 1 2004Fabrizio Panaro Abstract:, The evaluation of the small bowel vascular anatomy of living small bowel donors (LSBD) is usually performed with conventional angiography (CA). Recently, angio computed tomography (CT) has become a valid study of the vascular anatomy for kidney and liver living donors. We studied the applicability of angio CT with 3-D reconstruction (3-D-ACT) in the evaluation of LSBD. Potential LSBDs for pediatric transplant underwent both CA and 3-D-ACT to evaluate the anatomy of the distal branches of the superior mesenteric artery and vein. Angio-CT was performed with General Electric Lightspeed Scanner. The 3-D reconstruction was performed on the TeraRecon workstation. Adverse reactions, contrast dosage, test duration, invasiveness, hospital-stay, patient discomforts and accuracy were evaluated. Four potential donors (four female; mean age: 30.5 yr; mean BMI: 28.4) underwent both tests. Adverse reactions correlated to contrast agent used (90 mL CA, 150 mL 3-D-ACT) were not reported. CA required a hospitalization of 6 h as opposed to immediate discharge after the 3-D-ACT. The CA required the placement of transfemoral catheter and therefore greater patient discomfort than with 3-D-ACT. The 3-D-ACT arterial images were rated as equivalent to CA, however, 3-D-ACT venous images were rated better than the CA in all cases. CT-angiography with 3-D reconstruction is an acceptable method for vascular evaluation. When compared with routine angiography, it is less invasive, better tolerated and faster, but does require a significantly greater volume of venous contrast. 3-D-ACT also offers a better evaluation of the venous phase, and thus may become the test of choice to evaluate the vascular anatomies of LSBD candidates. [source] High trough levels of oral FK506 induced by loss of small intestinePEDIATRIC TRANSPLANTATION, Issue 6 2001Nobuyuki Sano Abstract: To establish a safe and effective usage of oral tacrolimus (FK506) in small bowel transplantation (SBTx) recipients, trough levels and area under the curve (AUC) values of FK506 were assessed using swine models of SBTx and short bowel. Thirty-eight Landrace male piglets were divided into four groups as follows: Group 1, controls (n=13); Group 2, a one-third small bowel model (n=5); Group 3, a short bowel model (n=10); and Group 4, a one-third small bowel allograft model (n=10; five donors and five recipients). Piglets of Groups 1 and 3 were further divided into two sub-groups, according to the route of drug administration: Groups 1a (n=10) and 3a (n=7) received FK506 orally, and Groups 1b (n=3) and 3b (n=3) received FK506 intravenously. Oral or intravenous FK506 was started on post-operative day 3 and continued until day 7 in each group. On day 7, trough levels and AUC values were measured. In Groups 1a, 2, 3a and 4, trough levels of FK506 were 2.1±1.2 (p<0.01 vs. Group 2, 3a or 4), 11.2±2.1, 23.3±4.8 (p<0.05 vs. Group 2 or 4) and 14.6±3.0 ng/mL, and AUC values were 101±90 (p<0.01 vs. Group 3a or 4), 319&±155, 808±200, and 531±113 ng.h/mL, respectively. Both trough levels and AUC values were lowest in Group 1a and highest in Group 3a. Between Groups 1b and 3b, there was no significant difference in the blood levels of intravenous FK506. The shorter the functioning residual small intestine was, the higher the trough level of oral FK506 was, while the presence or absence of small intestine did not affect blood levels of intravenous FK506. These results suggest that oral FK506 is metabolized in the functioning small intestine during its absorption. Therefore, events which cause intestinal malfunction, such as graft rejection in SBTx, inflammation and loss of small intestine, may adversely raise the trough level of oral FK506. [source] Influence of Immunosuppression on Alloresponse, Inflammation and Contractile Function of Graft After Intestinal TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010J. Fujishiro In small bowel transplantation (SBTx), graft manipulation, ischemia/reperfusion injury and acute rejection initiate a severe cellular and molecular inflammatory response in the muscularis propria leading to impaired motility of the graft. This study examined and compared the effect of tacrolimus and sirolimus on inflammation in graft muscularis. After allogeneic orthotopic SBTx, recipient rats were treated with tacrolimus or sirolimus. Tacrolimus and sirolimus attenuated neutrophilic, macrophage and T-cell infiltration in graft muscularis, which was associated with reduced apoptotic cell death. Nonspecific inflammatory mediators (IL-6, MCP-1) and T-cell activation markers (IL-2, IFN-,) were highly upregulated in allogeneic control graft muscularis 24 h and 7 days after SBTx, and tacrolimus and sirolimus significantly suppressed upregulation of these mediators. In vitro organ bath method demonstrated a severe decrease in graft smooth muscle contractility in allogeneic control (22% of normal control). Correlating with attenuated upregulation of iNOS, tacrolimus and sirolimus treatment significantly improved contractility (64% and 72%, respectively). Although sirolimus reduced cellular and molecular inflammatory response more efficiently after 24 h, contrary tacrolimus prevented acute rejection more efficiently. In conclusion, tacrolimus and sirolimus attenuate cellular and molecular inflammatory response in graft muscularis and subsequent dysmotility of the graft after allogeneic SBTx. [source] Pediatric Health-Related Quality of Life: Feasibility, Reliability and Validity of the PedsQLÔ Transplant ModuleAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010J. Weissberg-Benchell The measurement properties of the newly developed Pediatric Quality of Life InventoryÔ (PedsQLÔ) 3.0 Transplant Module in pediatric solid organ transplant recipients were evaluated. Participants included pediatric recipients of liver, kidney, heart and small bowel transplantation who were cared for at seven medical centers across the United States and their parents. Three hundred and thirty-eight parents of children ages 2,18 and 274 children ages 5,18 completed both the PedsQLÔ 4.0 Generic Core Scales and the Transplant Module. Findings suggest that child self-report and parent proxy-report scales on the Transplant Module demonstrated excellent reliability (total scale score for child self-report ,= 0.93; total scale score for parent proxy-report ,= 0.94). Transplant-specific symptoms or problems were significantly correlated with lower generic HRQOL, supporting construct validity. Children with solid organ transplants and their parents reported statistically significant lower generic HRQOL than healthy children. Parent and child reports showed moderate to good agreement across the scales. In conclusion, the PedsQLÔ Transplant Module demonstrated excellent initial feasibility, reliability and construct validity in pediatric patients with solid organ transplants. [source] Resident Macrophages are Involved in Intestinal Transplantation-Associated Inflammation and Motoric Dysfunction of the Graft MuscularisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2007N. Schaefer Gut manipulation and ischemia/reperfusion evoke an inflammatory response within the intestinal muscularis that contributes to dysmotility. We hypothesize that resident macrophages play a key role in initiating the inflammatory cascade. Isogenic small bowel transplantation was performed in Lewis rats. The impact of recovery of organs on muscularis inflammation was investigated by comparing cold whole-body perfusion after versus prior to recovery. The role of macrophages was investigated by transplantation of macrophage-depleted gut. Leukocytes were counted using muscularis whole mounts. Mediator expression was determined by real-time RT-PCR. Contractility was assessed in a standard organ bath. Both organ recovery and ischemia/reperfusion induced leukocyte recruitment and a significant upregulation in IL-6, MCP-1, ICAM-1 and iNOS mRNAs. Although organ recovery in cold ischemia prevented early gene expression, peak expression was not changed by modification of the recovery technique. Compared to controls, transplanted animals showed a 65% decrease in smooth muscle contractility. In contrast, transplanted macrophage-depleted isografts exhibited significant less leukocyte infiltration and only a 19% decrease in contractile activity. In summary, intestinal manipulation during recovery of organs initiates a functionally relevant inflammatory response within the intestinal muscularis that is massively intensified by the ischemia reperfusion injury. Resident muscularis macrophages participate in initiating this inflammatory response. [source] Endoscopic Diagnosis of Bleeding Meckel's Diverticulum in a Multivisceral Transplant RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2003Lawrence U. Liu Small bowel transplantation has become a life-saving procedure for patients with intestinal failure who fail conventional therapy. Meckel's diverticulum is a rare cause of occult gastrointestinal bleeding that has not been reported in patients receiving intestinal allografts. We report a case in which transplantation of an asymptomatic Meckel's diverticulum as part of a multivisceral allograft led to intestinal bleeding requiring surgical intervention. Endoscopy identified the actual bleeding diverticulum. Diverticulectomy at the time of transplant was not performed due to the difficult operative course, and the need for frequent surveillance ileoscopy, which would be performed across a fresh intestinal anastomosis. The patient underwent resection of the diverticulum, along with 40 cm of ileum, and did not experience further bleeding. [source] | ||||||||||