Small Bowel Transplantation: Report of a Clinical Case

Deltz, E.; Mengel, W.; Hamelmann, H.

doi:10.1007/978-3-642-87707-0_11

Cited by 44 publications

(31 citation statements)

References 11 publications

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“…The experimental work of Murase et al (12,30) and others (8) has supported the concept that the liver may shield the intestine from immunologic attack, but this advantage is relative only. The long survival of patient 1 in our series and that of the recipients of DeItz et al (6) and Ricour and Goulet et al (5) have demonstrated the feasibility of the technically less draconian procedure of isolated intestinal transplantation.…”

Section: Discussionsupporting

confidence: 62%

Cadaveric Small Bowel and Small Bowel-Liver Transplantation in Humans 1,2

et al. 1992

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Section: Discussionsupporting

confidence: 62%

Cadaveric Small Bowel and Small Bowel-Liver Transplantation in Humans 1,2

et al. 1992

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“…One way to assess the impact of a new immunosuppressive agent in transplantation is the ability to successfully transplant organs that was not considered feasible with standard immunosuppression. Success with intestinal transplantation under cyclosporine immunosuppression has been sporadic (24)(25)(26). A growing experience of small bowel transplantation.…”

Section: Fk506 (Prograt) a Macrolide Antibiotic Produced By The Fungmentioning

confidence: 99%

FK506 in Solid Organ Transplantation

Fung¹,

Starzl²

1995

Therapeutic Drug Monitoring

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Summary: FK506 (Prograt) is a new immunosuppressive agent. recently approved for use in solid organ transplants. The first use of FK506 was for the indication of refractory liver allograft rejection. This revealed a marked ability to reverse ongoing rejection. even in cases where chronic changes were observed. Between 50 and 70% of patients converted to FK506 had shown improvement. In long-term follow-up of patients with chronic rejection. 75% of patients were still alive at 3 years following FK506 conversion. and 65% of liver allografts were still functioning. FK506 has been compared to cyclosporine in primary liver transplantation. In the three randomized trials. freedom from rejection was statistically greater in the FK506-treated group, as compared to the cyclosporine-treated group. By intent-to-treat analysis, the patient and graft survival in the FK506 group was the same or better than the cyclosporine group. The good results in the cyclosporine limb was due. in part, to the ability of FK506 to treat rejection in the cyclosporine group. Freedom from steroid use, and the lower incidence of hypertension, were prominent features of FK506 patients. FK506 has been used for rescue of rejecting kidney allografts, with results similar to the liver transplant trials. When used as primary immunosuppression. FK506 was shown to be effective. as measured by graft survival. FK506-based immunosuppression has also been used in primary heart transplantation. as well as for primary adult pulmonary transplantation. Results from these small series of patients are equally encouraging. The results . of these studies suggest that FK506 is effective for solid organ transplantation. Both FK506 and cyclosporine administration have been associated with side effects. many of which are similar. and some of which are peculiar to a given organ transplant. Key Words: Tacrolimus-FK506-Solid organ transplantation. (1-4). The first clinical use of FK506 was for the indication of uncontrolled liver allograft rejection. which was therefore considered treatment failure of conventional immunosuppression (5-11). The results of this experience revealed a marked ability to reverse ongoing rejection, even in cases where chronic changes were observed. Between 50 and 70% of patients treated by FK506 (Prograt), a macrolide antibiotic produced by the fungus Streptomyces tsukubaensis is a new immunosuppressive agent 592conversion to FK506 had both clinical and histopathologic improvement. In a recent long-term follow-up of 113 patients with chronic rejection. 75% of patients were still alive at 3 years following FK506 conversion, and 65% of liver allografts were still functioning (8).Following an initial experience with FK506 as primary immunosuppression following liver transplantation at the University of Pittsburgh (12,13), FK506 has been compared to cyclosporine in primary liver transplantation, in randomized, nonblinded studies. At the University of Pittsburgh, low-risk candidates were randomized to FK506 with steroids as compared with cyclosporine...

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“…Small bowel transplantation has been successfully performed in various animal models and recently in humans using powerful immunosuppressive agents [4,7,9,23]. The small bowel is one of the most susceptible organs to ischemic and reperfusion injury because it contains a large amount of xanthine dehydrogenase-oxidase [2].…”

Section: Introductionmentioning

confidence: 99%

The significance of cytological examination on reperfusion in rat small intestinal transplantation

Taguchi

Yamada

Suita

et al. 1995

Vichows Archiv A Pathol Anat

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We examined the cytology of the exudate in preserved intestinal grafts on reperfusion and compared it with the histological findings in rat small intestinal transplantation. The jejunal graft was harvested from the Lewis rat and was preserved in University of Wisconsin solution for 6, 12, 24 and 48 h at 4 degrees C (n = 6, in each group) and was then syngeneically transplanted. On reperfusion, the exudate was collected and studied cytologically. Full thickness biopsies were performed at the end of the preservation and at 30 min after reperfusion for histological examination. Histological examination after reperfusion showed that the crypt layer was preserved until 24 h. However, it was destroyed by 48 h preservation. The cytological findings correlated with the depth of tissue injury shown histologically. The degeneration of villus epithelial cells, the decrease in the content of mucin in both the goblet cells as well as villus cells, and the appearance of crypt cells are all considered to be signs of poor graft viability. Cytological examination is therefore recommended as an effective, non-invasive and real-time method for evaluating graft viability just after reperfusion in small intestinal transplantation.

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Small Bowel Transplantation: Report of a Clinical Case

Cited by 44 publications

References 11 publications

Cadaveric Small Bowel and Small Bowel-Liver Transplantation in Humans 1,2

Cadaveric Small Bowel and Small Bowel-Liver Transplantation in Humans 1,2

FK506 in Solid Organ Transplantation

The significance of cytological examination on reperfusion in rat small intestinal transplantation

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