供体抗原经门静脉处理及移植物从门静脉回流对大鼠胰腺移植…

以３５只雄性ＳＤ大鼠为受体，制成糖尿病模型，以同龄Ｗｉｓｔａｒ雄性大鼠为供体，行全县腺移植。供体抗原分别经门静灌周围静脉处理，处理时间分别为移植前预处理或移植时处理，移植物静脉分别从门静脉或下腔静脉回流，结果表明供体抗原经门静脉预处理及移植物从门静脉加流对胰腺移植物功能存活的延长具有协同效应，移植时处理延长胰腺移植物效果不如移植前预处理，但可能具有一定的实用意义。     

供体抗原注入胸腺处理对大鼠胰腺移植功能存活的影响

在大鼠胰腺移植模型上将供体Ｗｉｓｔａｒ大鼠的脾细胞于移植前或移植时注入受体ＳＤ大鼠胸腺内，辅以短期免疫抑制剂，结果显示能明显延长胰腺移植物功能存活。崦单纯短期免疫抑制剂或单纯供体脾细胞注入胸腺均未能延长胰腺功能存活。提示供体脾细胞注入胸腺预处理延长胰腺功能存活效果优于移植时处理，但移植时处理可能更有实用价值。     

输入供体血对延长大鼠移植胰腺功能存活的初步研究

目的探索供体血输入同种大鼠对诱导胰腺移植耐受的可能性.方法用雄性Wistar大鼠作为实验的供受体,胰腺移植当天取供体大鼠全血1 ml,注入糖尿病受体大鼠腹腔,辅以短期的硫唑嘌呤(Aza). 结果移植胰腺功能存活时间为28～112天(平均64.2天),与单纯用硫唑嘌呤组(10.2天)或单纯输入供体血液组(9.8天)相比,移植胰腺功能存活时间显著延长(P<0.01).结论移植前短期使用免疫抑制剂以及移植当天输入供体血液,能延长大鼠移植胰腺功能存活时间.     

大鼠门静脉回流、胰液内引流术式胰腺移植模型的制作

目的 建立大鼠门脉回流、胰液内引流的胰腺移植动物模型。方法 以近交系雄性Wistar大鼠为供、受者，供胰门静脉与受者的肠纱膜上静脉在低位相吻合，形成门静脉回流；供者的十二指肠与受者的近端空肠相吻合。结果 67只药物诱导的糖尿病大鼠移植术后存活超过7d者46只，其中42只非禁食情况下血糖正常；46只存活的大鼠血胰岛素浓度正常。结论 该模型符合正常生理特点，可以用于胰腺移植的免疫和生理研究。     

大鼠胸腺内注射同种抗原对甲状旁腺移植物存活的影响

目的　改善甲状旁腺移植物的存活时间。方法　用SDLewis及DA大鼠进行甲状旁腺移植实验。由供体Lewis大鼠的脾细胞提取抗原。按照不同的抗原注射途径（尾静脉、门静脉及胸腺内）,是否合用抗淋巴细胞血清及第3品系大鼠的甲状旁腺移植共分为9组。结果　胸腺内注射抗原结合抗淋巴细胞血清的应用，使甲状旁腺移植物的平均存活期达到（196.00±3.96）d，与其他各组相比差异有非常显著性（P＜0.01）。结论　大鼠胸腺内注射抗原结合抗淋巴细胞血清的应用成功地诱导受体产生了供体特异性免疫耐受。     

不同热缺血时间对犬胰腺移植物功能及能量代谢状态的影响

目的探讨热缺血时间对胰腺能量代谢状态及胰腺移植后移植物功能的影响。方法切取犬胰腺左叶,按分组要求,胰腺分别经历30、60、90、120min热缺血,以0~4℃UW液灌洗,并保存24h,然后行胰腺节段自体异位移植,同时设正常对照组和未经历热缺血的胰腺节段自体移植组。术后连续观察血糖、静脉葡萄糖耐量试验(IVGTT)、血液中胰岛素含量,测定术后24h和1周时胰液中淀粉酶浓度,高效液相色谱法检测移植前胰腺组织中ATP和腺苷核苷酸总量(TAN),并观察移植后1h时移植物的组织学变化。结果热缺血30min组和60min组的术后3~5d血糖即可恢复至正常范围,而热缺血90min组和120min组术后1周血糖未能恢复至正常;术后1周,无热缺血组、热缺血30min组和60min组的IVGTTK值大于1,热缺血90min组和120min组小于1,且其静脉血中胰岛素的浓度明显低于无热缺血组、热缺血30min组和60min组(P<0.05);热缺血30min组和60min组胰腺组织中ATP和TAN的含量明显高于热缺血90min组和120min组(P<0.05);无热缺血组以及热缺血30min组和60min组的胰腺组织结构基本正常,而热缺血90min组和120min组的组织破坏明显,腺泡坏死、出血和炎症细胞浸润严重。结论用于移植的胰腺热缺血30~60min是安全的,移植后胰腺功能迅速恢复正常;超过60min的热缺血对移植物的能量代谢有显著负面影响。     

供体脾脏对大鼠移植胰腺转化生长因子-β1mRNA表达的影响

目的观察供体脾脏对胰腺移植免疫反应的影响.方法制作异基因大鼠胰、脾、十二指肠移植模型,观察供体胰腺的病理学变化,测定供体胰腺组织中转化生长因子(TGF)-β1 mR-NA的表达、CD4+和CD8+T淋巴细胞的变化.结果胰、脾、十二指肠移植组(A组)术后3 d胰腺小叶间质、腺泡和胰岛轻度水肿;5 d炎细胞浸润,腺泡细胞灶状坏死;7 d腺泡和胰岛部分坏死、自溶.胰、十二指肠移植组(B组)术后3 d胰腺腺泡片状坏死;5 d胰腺小叶和部分胰岛坏死.7 d腺泡大片坏死,胰岛结构消失.供体胰腺组织中,术后3、5、7 d TGF-β1 mRNA阳性细胞数,A组分别为66.75±8.56、36.50±6.70、36.88±6.06;B组分别为16.38±3.85、10.38±4.03、6.0±2 73.A组术后各时点TGF-β1mRNA的表达均高于B组(P<0.01);结论 TGF-β是减轻受体大鼠对供体胰腺免疫排斥反应的重要因素之一;调高供体胰腺组织TGF-β mRNA的表达是供体脾脏发挥免疫抑制作用的机制之一.     

大鼠胸腺内注射同种可溶性抗原对甲状旁腺移植物存活时间的影响

本研究应用从脾细胞撮的可溶性抗原胸腺内注射,结合ATS的使用,成功地诱导受体产生了供体特异性免疫耐受,使PTG移植物的平均存活期达196天以上。门静脉和尾静脉注射可溶性抗原无论是否合用ATS均不能诱导受体免疫无反应状态的产生。胸腺内注射同种可溶性抗原诱导免疫耐受的机制可能与功能性T细胞灭活/无反应或克隆清除有关。本研究在FTG临床移植中具有较大的应用价值。     

门静脉高压症患者的门静脉压对胰腺血运及功能的影响

目的 探讨门静脉高压症患者的门静脉压对胰腺血运及功能的影响。方法 选取2016年1月至2022年12月本院收治的肝炎后肝硬化门静脉高压症并有食道胃底静脉曲张破裂出血史的患者50例,随机分为两组,每组各25例,观察组采用门体部分分流加贲门周围血管离断术;对照组单纯行贲门周围血管离断术。比较两组手术前后稳定期门静脉压(portal vein pressure, PVP),手术前后胰腺平扫、增强扫描CT值的变化,进腹后、关腹前脾静脉及胰横动脉血流速度及手术前后胰腺内、外分泌指标血C肽及粪弹力蛋白酶-1浓度的变化。结果 观察组术后PVP明显低于对照组(P<0.01)。两组术前胰腺平扫、增强扫描CT值及增加值无明显差异(P>0.05)。观察组术后胰腺增强扫描CT值、增加值均明显高于对照组(P<0.01)。入腹后彩超测脾静脉(pv1)、胰横动脉(sv1)血流速度,两组无明显差异(P>0.05),关腹前再次测其速度(pv2, sv2),观察组明显快于对照组(P<0.01)。两组术前血C肽无明显差异(P>0.05),观察组术后1、 3、 5、 7 d高于对照组同时相...     

不同热缺血时间犬自体胰移植物功能状态及存活率的实验研究

目的探讨热缺血时间较长犬胰腺移植物功能和组织形态变化状态,研究不同热缺血时间条件下移植物存活率及供胰耐受热缺血的时限。方法根据供胰热缺血不同时间30、60、90、120 min分组,用UW液保存24 h,然后行自体移植,术后连续观察血糖、静脉葡萄糖耐量试验(IVGTT)、胰液淀粉酶、胰液分泌量、血液中胰岛素含量,并进行病理学检测。结果30 min组和60 min组在术后2~3 d即可恢复至正常范围,而在90 min组和120 min组术后1周血糖不能恢复至正常。IVGTT K值在未热缺血组3、0 min组和60 min组在术后1周>1,而在90 min组和120 min组<1。30 min组和60 min组术后胰液淀粉酶、胰液分泌量、血液中胰岛素含量明显高于90 min组和120 min组(P<0.05)。热缺血30、60、90、120 min各组移植物存活率分别为100%、100%、66.7%、0%。结论移植胰腺经过30~60 min热缺血,UW液保存24 h后移植物生存良好。热缺血时间超过90 min,移植物结构和功能难以恢复,存活率明显降低。     

门静脉和肠道引流式胰肾联合移植

目的 总结门静脉和肠道引流式胰肾联合移植的初步经验。方法 2001年6月～2003年6月共施行胰肾联合移植5例,其中胰腺引流2例采用体静脉．肠道引流(SED),3例采用门静脉-肠道引流(PED)。免疫抑制剂早期采用激素 霉酚酸酯(MMF) FK506 赛尼哌或舒莱四联诱导治疗,以后改为三联维持。结果 5例患者移植胰、肾功能术后1～7d恢复正常,停用胰岛素。术后未发生消化道瘘和血栓形成等手术技术相关的并发症,1例SED患者发生移植肾急性排斥反应,经激素冲击治疗后缓解。术后SED和PED各有1例患者因发生FK506中毒,最终死于败血症,死亡时移植胰腺功能正常。余3例经8、18、32个月随访,移植胰、肾功能良好,无远期并发症。结论 PED术式和SED术式在技术上安全可行,均无远期并发症,而PED术式在生理和免疫学方面更具优越性,可作为首选术式。     

Interstitial and vascular pancreas rejection in relation to graft survival

To examine the incidence of interstitial and vascular rejection in pancreas allografts and its impact on graft survival, we studied 36 percutaneous pancreas biopsies and 10 pancreas transplantectomy specimens from 32 patients who had undergone simultaneous pancreas-kidney transplantation. Interstitial rejection (IR) was predominantly found in the biopsies, while vascular rejection (VR) was most prominent in the transplantectomies. Pancreas graft survival was significantly decreased for pancreas grafts that had suffered from vascular rejection when compared to those with only interstitial rejection. Potential rejection markers, i. e., serum amylase, glucose, creatinine, and urinary amylase, did not correlate with histological signs of rejection, although increased levels of serum amylase were, in all but one case, associated with rejection.We conclude that a percutaneous pancreas biopsy remains the most reliable method to determine pancreas rejection, and that by distinguishing between IR andVR, a pancreas biopsy may provide important diagnostic as well as prognostic information. Received: 6 March 1997 Received after revision: 5 June 1997 Accepted: 30 June 1997     

Our experience with Roux-Y intestinal drainage in simultaneous kidney and pancreas transplantation

Abstract Enteric drainage is a sound surgical technique in SKP, and it avoids the majority of urological as well as metabolic complications. We did not see an increase in intraabdominal complications or of graft loss due to rejection. Intestinal leak is rare and easily managed provided a Roux-Y loop of jejunum is used. Even though the number of patients was small and the follow-up short, the results of the RY group were at least comparable to the BD group. In view of our results, we plan to use this technique in all our future SKP patients.     

Effect of blood group and HLA matching on pancreas graft survival with the use of UW solution

Pancreas graft survival is influenced by various donor and recipient factors. Factors that have posed serious problems to pancreas transplantation have included the limited cold ischemia time, early graft thrombosis, and rejection. A limited cold ischemia time not only causes problems in terms of logistics but also implies limitations with regard to HLA matching and organ exchange. Between August 1988 and August 1989 we performed a prospective, nonrandomized European multicenter study to evaluate the effect of University of Wisconsin (UW) solution on pancreas graft survival. In addition, donor and recipient factors were collected and their influence on graft survival analyzed. Overall pancreas graft survival at 1 and 4 years was 67% and 59%, respectively (n=62). When only simultaneous pancreas and kidney transplants were included, the graft survival was 70% and 63% at 1 and 4 years, respectively. The incidence of pancreas graft thrombosis was 8%. Cold ischemia time was not found to significantly influence pancreas graft survival even when it exceeded 12h. Factors that did were HLA-DR matching, simultaneous pancreas and kidney transplantation versus pancreas transplantation alone, and ABO blood group matching. We feel that the use of UW solution for pancreas preservation has contributed to improved pancreas graft survival and has reduced early graft thrombosis despite much longer cold ischemia times of over 12 h. Given this and the significant effect of HLA and blood group matching, we conclude that more attention should be paid to preoperative matching and organ exchange in order to further improve pancreas graft survival.     

Effects of cyclosporin A on the blood flow of the native and transplanted rat pancreas and duodenum

The aim of the present study was to evaluate the effects of cyclosporin A (CyA) on the blood perfusion of the transplanted pancreas. For this purpose syngeneic pancreaticoduodenal transplantations were performed in Wistar-Furth rats. After nephrectomy the graft was anastomosed using a nonsuturing cuff technique to the left renal vessels. Beginning 7 days after transplantation and then continuing for 2 weeks, CyA (15 mg/kg body weight) or vehicle was given p.o. once daily, 6 days a week. The serum CyA concentrations were greater than 600 ng/ml at all points in time tested. Intraperitoneal glucose tolerance tests were normal in CyA-treated animals after 12 days, but the pancreatic insulin concentration was decreased to the same extent in the native and transplanted pancreas. A microsphere technique was used to measure the blood perfusion of the pancreaticoduodenal graft, the native pancreas and duodenum, and remaining kidney 14 days after starting the CyA treatment. The renal blood flow was markedly decreased by CyA when compared with the control animals. In rats given vehicle alone, pancreatic, islet, and duodenal blood flows were higher in the graft than in the corresponding native organs. However, in rats given CyA, hyperperfusion of the graft was not observed. We conclude that the administration of CyA prevents the transplantation-induced blood flow increase seen in pancreaticoduodenal grafts of vehicle-treated rats. These observations may reflect graft denervation.     

Pretransplant portal venous administration of donor antigen and portal venous allograft drainage synergistically prolong rat cardiac allograft survival

The effect of antigen given through the portal vein (PV) before transplantation or continuous drainage of a graft into the PV results in moderate prolongation of allograft survival. This study examines these treatment modalities further. Pretransplant donor antigen as 25 x 10(6) ultraviolet B-irradiated (12,000 joules/m2) donor spleen cells was given 7 days before heart transplantation through either the PV or systemic venous (IV) routes. On day 0, Lewis-to-Buffalo rat cardiac allografts were drained either into the PV or IV. Pretransplant PV donor antigen administration (p less than 0.005), but not by IV administration, significantly prolonged cardiac allograft survival across the strong RT 1 rat histoincompatibility barrier. Similarly PV, but not IV, drainage of the graft prolonged graft survival (p less than 0.005). Pretransplant IV antigen administration had no additive effect on PV drainage graft survival. In contrast, when pretransplant PV donor antigen was combined with PV drainage, 11 of 14 allografts (p less than 0.001) continued to function, free of rejection, after 150 days. Therefore for rat cardiac transplants a clearly synergistic graft-prolonging effect results when pretransplant PV donor antigen is combined with PV drainage of the allograts. These data clarify the potent tolerogenic effects of alloantigen not only administered into the PV but also continuously shed intraportally so that it is first processed by the liver.     

膀胱引流式胰肾联合移植术后严重代谢性酸中毒的外科治疗

目的探讨膀胱引流式胰肾联合移植长期存活受者代谢性酸中毒的治疗方法。方法1例女性45岁糖尿病肾病、尿毒症患者膀胱引流式胰肾联合移植术后3年并发严重代谢性酸中毒，二次手术改为同肠引流。绕移植胰腺十二指肠膀胱吻合口切除已游离的带膀胱擘吻合口，于距同盲部40cm处回肠与移植胰腺十二指肠段行侧侧吻合，吻合口长约5cm，距吻合口15cm处冉行回肠襻侧侧吻合。结果患者术后恢复好。服用常规免疫抑制剂，住院30d。随访4年，患者血气分析正常。肾功能、血糖波动在正常范围。结论膀胱引流式胰肾联合移植术后严重代谢性酸中毒患者改用回肠引流是一种有效、安全的治疗方法。