Nutritional condition and absorptive capacity of 14 infants with short bowel syndrome

We examined the absorptive capacity and the nutritional condition of 14 infants with short bowel syndrome, whose residual small intestine was 90 cm or less. Their age ranged from 1 year to 18 years. Examined items were body weight, height, serum albumin, total cholesterol, triglyceride, fat soluble vitamins, trace elements and rapid turn over protein as markers of the nutritional condition. Fecal fat, fecal bile acid, d-xylose absorption test, sugar-, amino acid-evoked potential difference in the small intestine and disaccharidase activity of the mucosa were examined as markers of the absorptive capacity. Our results showed that the body weight was below the normal range in the patients with small intestine of less than 50 cm. Most nutritional markers were within normal range, however, cholesterol and vitamin D were low in the patients with fat malabsorption, especially in patients with less than 50 cm of small intestine. Fecal bile acid was higher than the normal range in all the patients. Potential difference was in normal range or slightly lower than normal in all the patients. We concluded that infants with less than 50 cm of small intestine had malabsorption of sugar, protein and fat. Therefore, prolonged nutrient support, especially fat, is necessary.     

Rejection following donor or recipient preoperative treatment with FTY720 in rat small bowel transplantation

BACKGROUND: Severe rejection of small bowel transplantation (SBTx) has been ascribed to abundant lymphoid tissues in the small intestine without well-established evidence. However, the role of donor lymphocytes in rejection is still unclear. The novel immunosuppressant, FTY720, is reported to transfer peripheral blood lymphocytes (PBLs) to lymphoid tissues such as mesenteric lymph nodes (MLNs) and Peyer patches (PP). In the present study, the number of donor lymphocytes in the graft was increased by FTY720, and the influence on rejection was studied in a rat model. Furthermore, the number of the PBL of recipient was decreased by FTY720 before SBTx and the effect on rejection was examined. MATERIALS AND METHODS: Orthotopic total SBTx was performed in Brown-Norway and Lewis rats. In the donor pretreatment study, FTY720 was administrated to donor rats 24 h prior to harvesting to increase the number of graft lymphocytes (FTY donor-pretreated group). In contrast, MLNs were surgically removed from the grafts to decrease the number of graft lymphocytes (MLN-resected group). In the recipient pretreatment study, FTY720 was administrated to recipient rats 24 h before SBTx to decrease recipient PBL (FTY group). In contrast, a subclinical dose of cyclosporine A (CsA) was administrated after SBTx (CsA group). Rats were administrated preoperative FTY720 combined with post-SBTx CsA (FTY+CsA group). Graft survival, pathology, lymphocyte count, and subtype were examined. RESULTS: In the donor pretreatment study, pretreatment with FTY720 did not enhance graft rejection. MLN resection did not prolong graft survival. In the recipient pretreatment study, FTY720 caused a significant reduction in the number of infiltrating lymphocytes in the graft, as well as the percentage of recipient CD4+ and CD25+ cells within the graft. FTY720 and CsA synergistically prolonged graft survival. CONCLUSION: SBTx rejection correlated with the number of recipient PBL, and not with the number of donor lymphocytes transplanted together with the graft. The pretreatment of the recipient with FTY720 was effective in the case of combined use of the low-dose postoperative CsA.     

Review of various techniques of small bowel transplantation in pigs

Because of anatomical and physiological similarities to humans, porcine small bowel transplantation (SBTx) can be used as an appropriate experimental model in the field of surgical research. Various approaches to SBTx have been described in literature. The aim of this work is to present a review of different surgical techniques of SBTx which have been developed using the porcine model. Our analysis of Medline-cited studies dealing with different techniques of SBTx in porcine models was particularly focused on surgical aspects. With regard to graft procurement and enterectomy, the reported techniques vary widely. Arterial reconstruction is mainly conducted by performing the anastomosis between the superior mesenteric artery (SMA) of the donor and SMA or infrarenal aorta of the recipient. Alternatively, an aortic segment of the donor can be anastomosed to the infrarenal aorta of the recipient. Venous anastomosis is frequently performed between the superior mesenteric vein (SMV) of the donor and SMV or the inferior vena cava (IVC) of the recipient. Some studies also report venous anastomosis between the portal vein of the donor and the recipient. Bowel continuity is then restored by end-to-end or end-to-side anastomosis. Remarkable results were generated thanks to improved techniques which include proximal side-to-side ileo-ileal anastomosis with double-barrel ileostomy, or so-called "Paul-Mikulicz-Ileostomy". Most frequently used were jejunostomy and the "Bishop-Koop-Ileostomy"--where the proximal part of the bowel is anastomosed end-to-side to the distal part, which is then exteriorized as an ostomy. Based on the techniques presented in this review, one must select the most suitable surgical technique of porcine SBTx among those various models.     

Progressive functional adaptation of segmental bowel graft from living related donor

We report a patient with short gut syndrome successfully treated with living related bowel transplantation. A 27-year-old Caucasian man was referred after traumatic loss of almost the entire bowel from the third portion of duodenum to the sigmoid colon. His HLA-identical sister volunteered as a donor. A 200-cm segment of ileum was successfully transplanted under tacrolimus-based immunosuppression. The posttransplant course was uneventful, without rejection or infectious complication. Total parenteral nutrition was discontinued 1 week posttransplant. At 6 months the patient had returned to his preinjury weight. Water and D-xylose absorption as well as fecal fat studies were markedly abnormal 1 month posttransplant but normalized by 6 months. The donor recovery was uneventful. A well-matched segmental ileal graft from living donor can provide complete rehabilitation for patients with short gut syndrome. We documented a progressive functional adaptation of the ileal graft, resulting in normal absorption by 5 months posttransplantation.     

Tricortical Calcaneal Bone Graft and Management of the Donor Site

The clinical outcomes of 19 patients requiring autogenous grafts for foot surgery were followed up until healing at the donor site occurred. In all cases, tricortical bone was extracted from the calcaneus for use at another pedal site. The first cohort of 9 patients had the calcaneal deficit replaced with allogenic cubes. The second cohort received no tissue replacement. Patients were reviewed postoperatively with a questionnaire and clinical examination to evaluate the outcome of the operations. Radiographic outcomes were observed at the donor and recipient sites in both groups until healing was confirmed as bridging trabeculation. Incorporation of the graft at the donor site was also reviewed. Clinical outcomes, namely pain, local sensory function, and return to footwear, were satisfactory in all patients and were not significantly different between groups. One patient from each group sustained a heel fracture. The donated autogenous grafts at the recipient sites were all incorporated uneventfully at 6 months. In the first cohort, allogenic graft incorporation in the calcaneus was complete in only 2 patients at the 12-month stage. The remaining 7 cases showed reduction of the deficit by new bone formation arising from the calcaneus. Donor sites with allogenic bone replacement healed at a median of 18 months (interquartile range, 18-18 months). In the group without replacement, healing occurred at a median of 6 months (interquartile range, 6-12 months), a highly statistically significant difference (P < .001). In the second cohort without allogenic graft replacement, radiographic filling at the donor site was complete within a 12-month period. Tricortical bone can be successfully harvested from the calcaneus, but there may an associated risk of heel fracture. The role of replacement allogenic bone in assisting healing at the donor site is unclear.     

Regulation of donor T cells in the tolerant rats to graft-versus-host disease by FTY720 following small bowel transplantation

AIMS: The potency of immunosuppression is a critical factor in small bowel transplantation (SBTx). FTY720 altered lymphocyte trafficking and prevented the donor T cells from migrating into target organs, resulting in the prolongation of recipient survival in acute graft-versus-host disease (GVHD) of SBTx. However, the effect of FTY720 on donor T cells in the chronic phase of GVHD following SBTx remains unclear. METHODS: Heterotopic SBTx was performed in a WF-to-F1 (WF x ACI) rat combination. Recipients were given FTY720 for 14 days after SBTx. The subpopulations of donor-derived T cells and the cytokine production in the target tissues were evaluated on postoperative day 150. RESULTS: FTY720 treatment significantly prolonged recipient survival over 150 days without any clinical signs of GVHD. The numbers of donor-derived CD4+ and CD8+ T cells in the peripheral blood, mesenteric lymph nodes, and Peyer's patches of recipients were maintained at low levels on postoperative 150, which were almost similar to the levels on postoperative day 14. In the host lamina propria, however, a significant higher number of donor T cells (CD4+, 18.4 +/- 4.3 x 10(4); CD8+, 13.9 +/- 3.6 x 10(4)) were still observed on postoperative day 150. Production of interferon-gamma was significantly reduced in target tissues by FTY720 treatment both in the acute and chronic phase. However, interleukin-4 and interleukin-10 production, which was significantly higher on day 14, returned to the level of naive rats in the chronic phase. CONCLUSIONS: A 14-day treatment of FTY720 induced tolerance in our SBTx model. Down-regulation of both Th1 and Th2 immune response was observed in the chronic phase.     

Low bioavailability of cyclosporine microemulsion and tacrolimus in a small bowel transplant recipient: possible relationship to intestinal P-glycoprotein activity

With intestine transplants the allograft is dependent on itself for maintenance of adequate immunosuppression. We evaluated an intestinal transplant recipient who required very large doses of either tacrolimus or cyclosporine emulsion to achieve acceptable blood concentrations. Pharmacokinetic studies revealed bioavailabilities of 2% and 6% respectively, while D-xylose and B12 absorption were found to be within normal limits and fecal fat was only slightly increased, suggesting that there was a selective absorptive defect for these drugs. Biopsies of the allograft ileum revealed a high P-glycoprotein activity compared to the jejunum or to intestinal biopsies from other normal subjects. This may be a contributing factor to poor immunosuppressive drug absorption in this patient and others.     

小肠移植术后巨细胞病毒感染二例的治疗体会

目的 总结小肠移植术后巨细胞病毒(CMV)感染的治疗经验.方法 1994年至2009年间完成15例小肠移植,分为3个阶段:1994-1995年为第1阶段(3例),2003-2006年为第2阶段(7例),2007年以后为第3阶段(5例).第1阶段术后未进行CMV感染的预防;第2阶段通过肠镜、病理检查和血清学检查(CMV IgM、CMV pp65和CMV DNA)进行CMV感染的诊断,术后静脉注射更昔洛韦2~3周,口服阿昔洛韦3个月以预防CMV感染;第3阶段在第2阶段的基础上,应用实时定量PCR技术检测CMV DNA,并制定计划性监测方案,术后静脉注射更昔洛韦2~3周,口服更昔洛韦3个月预防CMV感染,采用CMV感染的抢先治疗方案.结果 15例患者中有2例(13.3 %)术后发生CMV感染.其中第2阶段1例术后45 d发生移植肠CMV肠炎,术后64 d并发CMV肺炎,应用更昔洛韦和胸腺肽,并停用他克莫司,最终转为重度排斥反应后死亡;第3阶段1例术后第3个月发生CMV感染,经CMV抢先治疗后治愈.结论 小肠移植术后应进行CMV的预防性治疗,严密监测CMV血清学指标,适时进行抢先治疗.对于CMV侵袭性疾病在进行有效治疗的同时应注意排斥反应的发生.

Abstract：

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.     

Analysis of marginal donor parameters in liver transplantation for primary biliary cirrhosis

The shortage in cadaveric donor livers is pushing the transplant centers to expand the pool by using "marginal" donors. Primary biliary cirrhosis (PBC) remains an important indication for transplantation. We conducted a retrospective analysis of prospectively collected data in a well-defined group of patients with PBC where 301 consecutive donor-PBC recipient pairs transplanted were analyzed to identify donor and operative factors influencing recipient outcome. Mean follow-up was 56 months. The 1-, 3- and 5-year actuarial patient and graft survival was 93.97%, 90.64%, and 81.75%, and 85.49%, 82.57%, and 75.21%, respectively. Factors showing influence in decreased total patient survival were recipient old age (P = 0.003) and low recipient albumin (P = 0.01). However, the only variables showing an association with decreased patient survival within 90 days are old donor age (P = 0.002) and high donor body weight (P = 0.03) or high body mass index (BMI) (P = 0.055). Cold ischaemic time (CIT) of 18 hours showed statistical significance in patient survival (P = 0.025). Obesity did have a significant adverse impact on survival compared with normal or overweight donors (BMI < 30), decreasing survival by 50% at 5 years. In conclusion, this study of several factors considered "marginal" for transplantation in a recipient population with predictable liver disease (PBC), donor BMI and age were shown to be associated with decreased graft and patient survival.     

活体小肠移植术供体的选择及处置

目的 探讨活体小肠移植供体的选择原则和处置。方法 对我国首次成功的2例临床活体小肠移植进行回顾性研究。受体均为短肠综合征患。患1由其父供末端回肠150cm;患2接受其母亲末端回肠160cm。两供体的组织配型HLA与各自的受体半相符,ABO血型相同。供体进行严格的体检,肠镜及钡剂造影确定小肠的长度合适,D－木糖吸收实验证实吸收功能正常,血管造影示肠系膜血管分布正常。术前严格肠道准备,术中细致取肠及运用4℃UW液进行重力灌洗。供体术后常规处理。结果 两名供体术后恢复顺利,无手术并发症,肠道吸收功能恢复正常。受体1目前已经健康存活24个月,正常进食,生活自理,体重增加20kg;受体2已健康存活5个月。2例均出现了1次急性排斥反应,但经激素冲击治疗后得到控制。结论 选用组织相容性好、健康标准体重的亲体作为供体,术前供体的充分准备、术中细致操作、术后细心管理,是保证移植小肠存活和供体手术安全的关键。     

小肠移植后并发侵袭性真菌感染的治疗

目的 总结小肠移植术后侵袭性真菌感染(IFI)的治疗经验和教训.方法 将1994年至2009年6月间15例小肠移植患者分为3个阶段,1994-1995年的3例患者为第1阶段,2003-2006年的7例患者为第2阶段,2007年以后的5例患者为第3阶段.第1和第2阶段患者围手术期真菌感染的预防方案采用静脉注射氟康唑,IFI的治疗以静脉注射氟康唑为主,在病情危重时静脉注射两性霉素B或两性霉素B脂质体,首次用量为1～5 mg/d(或0.02～0.10 mg·kg~(-1)·d~(-1)),视患者耐受情况每日增加5 mg;第3阶段患者围手术期真菌感染的预防方案采用静脉注射两性霉素B脂质体,治疗IFI时,两性霉素B脂质体首次给药便达到目标治疗剂量,用量高达6 mg·kg~(-1)·d~(-1),并严密监测患者的生命体征,肝肾功能及电解质的变化,根据患者病情的变化和肾功能的状况调整剂量.结果 15例患者中有4例术后发生IFI,发生率为26.7%,其中第1、2和第3阶段患者中分别有1例、2例和1例发生IFI.第1和第2阶段3例发生IFI的患者经治疗无效死于严重IFI,第3阶段1例发生IFI的患者经两性霉素B脂质体治疗44 d后被成功救治.治疗期间,患者尿素氮和血清肌酐水平均显著升高,停药后逐渐下降至正常水平.3个阶段患者总体病死率为75%.结论 小肠移植术后IFI是极其凶险的并发症,病死率极高;两性霉素B脂质体能够成功救治IFI患者,在严密监测肾功能下,大剂量应用两性霉素B脂质体是安全的.     

亲属活体单段供肝移植治疗极低体重婴儿胆道闭锁一例

目的 总结亲属活体单段供肝移植治疗极低体重婴儿胆道闭锁的临床经验.方法 受者为出生仅145 d的男婴,身高66 crn,体量3.08 kg,被确诊为胆道闭锁伴肝硬化.供者为患儿母亲,年龄36岁,身高145 cm,体重47 kg.采用改良背驮式原位肝移植术,切取供者Ⅱ段肝组织作为供肝,移植肝体积与受者标准肝体积比值为92.5%,GRWR为5.19%,供肝动脉与受者肝右动脉用供者左侧股外侧浅隐静脉搭桥行端端吻合,受者三支肝静脉经整合后与供肝静脉行端端吻合,供肝胆管与受者空肠行Roux-en-Y吻合.术后监测供、受者生命体征、肝肾功能及出血和凝血状况等,常规抗感染治疗.受者术后采用环孢素A、吗替麦考酚酯及甲泼尼龙的方案预防排斥反应.结果 供肝切取手术历时370 min,术中供者出血150 ml均回输,切取供肝重量为160 g.肝移植手术历时451min,术中受者失血230 ml,输注全血200 ml和红细胞悬液50 m1,无肝期时间为71 min,供肝冷缺血时间为132 min.供者恢复顺利,术后8 d拆线出院.受者术后5 d肝功能基本恢复正常,术后7 d各项化验指标均正常.但术后7和15 d时,受者分别发生肠道吻合口漏各1次,经修补后痊愈.受者于术后35 d出院,出院时体重增加0.3 kg,各方面与同龄婴儿相当.结论 亲属活体单段供肝移植是治疗极低体重患儿终未期肝病的一种可供选择的治疗方法,经充分的术前评估、精细的手术操作及良好的围手术期管理后,手术能取得良好效果.     

母子亲体小肠移植治疗小肠衰竭的方法及疗效探讨：附1例报告

目的：探讨母子亲体小肠移植的方法及其对短肠综合征所致小肠衰竭的疗效。方法：为1名15岁短肠综合征（仅残留小肠8cm）致小肠衰竭的男患者行小肠移植术。供体为患者母亲。取供体带血管蒂回肠中下段1.2m移植于受体腹腔，两端分别造瘘及作人工肛。二期手术于6个月后施行，将受体残余肠中部横断，上下端分别与供肠近、远段行端侧吻合。结果：供、受体手术顺利。受体一期手术后曾发生感染及排斥，经治疗后痊愈。二次术后随访8个月，受体小肠功能逐渐恢复，患者体重明显增加，一般情况好，进食半流质，生活能自理。结论：亲体小肠移植是治疗短肠综合征肠衰竭的有效方法。排斥和感染是威胁小肠移植安全的主要因素。     

游离桡动脉联体穿支皮瓣修复手指较大皮肤软组织缺损

目的探讨游离桡动脉联体穿支皮瓣修复手指较大皮肤软组织缺损的方法及临床疗效。方法2015年6月-2019年8月,采用桡动脉联体穿支皮瓣修复手指较大皮肤软组织缺损11例,皮瓣切取范围为2.5 cm×5.5 cm^3.0 cm×7.5 cm。供区直接拉拢缝合。术后随访3~26个月,观察皮瓣的质地、外观、感觉及手指功能情况。结果11例皮瓣全部顺利成活,伤口均Ⅰ期愈合。术后9例获得随访,随访时间3~26个月,平均18个月。皮瓣质地好,未见明显臃肿,皮色与受区相近,两点辨别觉8~12 mm,平均10 mm。供区只留线性瘢痕。结论采用桡动脉联体穿支皮瓣修复手指较大皮肤软组织缺损,增加了皮瓣的切取范围,不损伤主干血管,切取简便,成活率高,色泽和质地与受区相近,手指功能良好,供区可直接缝合,是修复手指较大皮肤缺损的一种理想方法。     

Causes of secondary hyperparathyroidism in a healthy population: the Tromsø study

Secondary hyperparathyroidism (SHPT) develops as a compensatory mechanism when the body is in calcium deficit. SHPT may be harmful and has been associated with elevated blood pressure. The cause of SHPT could be low calcium intake, reduced intestinal calcium absorption, or increased excretion. However, the relative importance of these factors for the development of SHPT is not known. During the 5th Tromsø study, serum PTH and calcium were measured in 7954 subjects. Then 96 subjects with SHPT (defined as serum PTH above 6.4?pmol/l together with serum calcium below 2.40?mmol/l) and 106 control subjects were examined at follow-up with a food frequency questionnaire, calcium absorption test, measurement of 24-h urinary calcium excretion, and serum vitamin D status. The statistical analyses showed several interactions necessitating subgroup analysis. It was found that the calcium intake was significantly lower in the SHPT group, but only in nonsmoking males; the calcium absorption was nonsignificantly higher in the SHPT group; the serum 25-hydroxyvitamin D levels were significantly lower in the SHPT group but only in nonsmokers; and the 24-h urinary calcium excretion was significantly lower in the SHPT group but only in those not on blood pressure medication. The most frequent cause of SHPT appeared to be low calcium intake (18%) and a low serum 25-hydroxyvitamin D level (18%). However, in most subjects with SHPT all tests were within the normal range, and the cause is therefore probably a combination of several factors.     

Transplantation of Kidneys from Deceased Adult Polycystic Donors

Renal transplantation is the best treatment for end-stage renal disease. The discrepancy between donor organ supply and demand continues to widen. Maximum efforts should be made to make use of donor kidneys and we suggest that polycystic kidneys can be suitable marginal donor organs. Five polycystic cadaveric donor kidneys were transplanted in four recipients at our institution between year 2000 and 2004. The donor kidneys were either of normal size or moderately enlarged (less than 15 x 10 cm). Donor ages were 24, 46 and 55 years. All donors had normal serum creatinine at the time of organ retrieval. Recipients gave informed consent to be transplanted with the polycystic kidneys. Three of four recipients had primary graft function. The patient with primary nonfunction required graft nephrectomy 8 weeks post-transplantation. One patient died due to cardiovascular causes with a functioning graft 18 months after transplantation. Two patients remain well, 26 and 58 months after transplantation, with normal graft function. Our experience and the limited evidence from the literature suggest that, with careful selection of both donor and recipient, transplantation of cadaveric polycystic donor kidneys should be considered given the current organ shortage.     

临床同种活体部分小肠移植：附1例报告

目的：探讨临床同种活体小肠移植治疗短肠综合征的效果。方法：对1例因小肠扭转而切除大部分小肠和右半结肠，残留小肠仅20cm的超短肠综合征男性患者，行亲属活体同种部分小肠移植。供体为患者之母。受体术前行供体特异性输血，50mL/周，共8周。供受体巨细胞病毒感染状态均为阴性。移植肠长约160cm。移植肠的回结肠动静脉分别与受体肾下腹主动脉和下腔静脉端侧吻合，移植肠末端造口。术后给予抗排斥、抗感染、抗凝及营养支持治疗。结果：供体术后恢复顺利，无并发症。受体已健康存活31周，无感染和排斥反应。术后8周脱离肠外营养治疗，口服低脂饮食，D－木糖吸收试验结果接近正常。结论：同种活体部分小肠移植是治疗短肠综合征的有效措施。     

Fecal fat, cyclosporine, and alpha 1-antitrypsin for assessment of small bowel function following transplantation

Many factors affect the integrity of transplanted small bowel. These include ischemic preservation and immunologic injury as well as the division of intestinal lymphatics during transplantation. This study was undertaken to evaluate the recovery of fat absorption in transplanted small bowel in syngeneic rats. Orthotopic transplantation of the total small bowel with resection of the native intestine was performed. The experimental (n = 11) and a pair-fed, sham-operated control (n = 8) groups were fed a 50% kcal corn oil semipurified diet. Studies of cyclosporine (CSA) absorption, maltose absorption, dietary fat, and fecal alpha 1-antitrypsin (FA1AT) excretion in transplanted animals were performed preoperatively and at 15, 30, and 50 days postoperatively. There was no significant difference in the weight change or fat and maltose absorption in experimental animals compared with control animals at any time point. Peak serum CSA levels were lower at day 15 in transplanted animals than in controls (P = 0.006) and improved but remained lower than those in controls at days 30 and 50 (P = 0.017). FA1AT excretion was increased on postoperative day 15 (accompanied by a decrease in body weight) and returned to control levels at days 30 and 50. Transplanted isogeneic rats had weight recovery and fat and carbohydrate absorption similar to those of controls. Transplanted animals had a protein-losing enteropathy measured by FA1AT at day 15 that resolved by 30 and 50 days, respectively. CSA absorption showed a much more gradual return to control levels and remained abnormal at 50 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of the ratio of graft kidney volume to recipient body surface area on graft function after live donor kidney transplantation

Functioning nephron mass is a determinant of the graft function of kidney transplant recipients. The graft kidney volume and its weight have been reported to be surrogates of the nephron mass. To investigate the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on the graft function within six months post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery. Ninety-four cases of live donor kidney transplants were included in this study. The graft kidney volume/recipient BSA ratio was correlated with the glomerular filtration rate (GFR) of recipients at one and six months post-transplantation (r = 0.416, p < 0.001 and r = 0.381, p < 0.001, respectively). We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of ≥90.9 mL/m(2) and those with a ratio of <90.9 mL/m(2) (p < 0.001). Multivariate analysis demonstrated that the graft kidney volume/recipient BSA ratio and donor age are independent predictors of recipient GFR at one and six months post-transplantation (p < 0.05). During living donor and recipient matching, both the potential volume of the donated kidney and the body size of recipient should be considered.     

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??Clinical study on splanchnic hemodynamic changes after living donor liver transplantation for patients with portal hypertension JIANG Shui-ming, ZHOU Guang-wen, SHEN Chuan, et al. Department of Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Corresponding author ??ZHOU Guang-wen, E-mail??gw_vrai@yahoo.com.cn
Abstract Objective To study the splanchnic hemodynamic changes after living donor liver transplantation (LDLT). At same time, the effect of such changes on collateral circulation and postoperative liver function was evaluated too. Methods Between 2006 and 2008, in 18 patients with portal hypertension underwent LDLT, the following parameters were measured preoperatively and postoperative days 1, 3, 5, 7; and 1, 3 months after LDLT with Color Doppler sonography: portal blood flow volume (PBF), portal blood flow mean velocity (PBV), hepatic artery resistance indexes (HA-RI). The same parameters were measured in 18 living donors as contrast. Postoperative graft and spleen volume were estimated by computed tomography. Results In recipient group, portal venous pressure was decreased, but was higher than normal value after LDLT. PBF and PBV increased and achieved peak value in first day after LDLT (from 1081±278 mL/min to 2171±613 mL/min and from 15±5.7 cm/s to 56±22.1 cm/s, respectively, P<0.01). Although a progressive reduction of PBF and PBV was observed during the follow-up, until 3 months after LDLT, PBF and PBV were significantly greater than donor group (P<0.05). In donor group, although PBF had no change after LDLT, PBV increased (from 23.7±7.2 cm/s to 30.7±7.5 cm/s, P<0.05), and returned to normal after 1 month. Graft and residual liver regenerated rapidly after LDLT. Graft and residual liver volume reached 1426.2±203.4mL and 1139.3±153.1mL respectively. A clear and rapid improvement in splenomegaly was presented in recipient group, whereas spleen size increased postoperative in donor group. Conclusions A high portal flow was present in cirrhosis with portal hypertension after LDLT.The possible causes for this can be persistence of considerable splenomegaly. Splenic artery is effective management modality for preventing portal hyperperfusion injury.