Report of initial experience in small bowel transplantation at São José do Rio Preto Medical School Hospital.

Intestinal failure is the patient's inability to maintain hydroelectric and nutritional support by the digestive route, arising from massive enterectomy or diseases in which the bowel is incapable of adequately absorbing fluids and nutrients. Patients with intestinal failure associated with short bowel syndrome (SBS) and with other functional diseases with malabsorption or with total parenteral nutrition-related complications (recurrent sepsis and thrombosis of one or more deep venous accesses) are candidates for small bowel transplantation (SBT), which can be an isolated small bowel, a combined liver and small bowel, or a multivisceral graft. At our institution, three isolated SBTs were performed as our initial experience with this transplant.

The impact of Campath 1H induction in adult liver allotransplantation.

BACKGROUND: We report our experience with Campath 1H in adult liver allotransplantation. METHODS: Between December 2001 and February 2004, 77 patients underwent liver transplantation using Campath 1H induction and low-dose maintenance tacrolimus immunosuppression. The control group consisted of 50 patients with similar baseline characteristics and the same eligibility criteria, transplanted under our standard Tacrolimus/steroids regimen. Hepatitis C patients were excluded from the study. RESULTS: Patient and graft survival were similar for both groups. The incidence of rejection was significantly lower in the Campath vs the control group (51% vs 65% at 12 months, P = .009). Tacrolimus trough levels and conversion from Tacrolimus or the addition of other immunosuppressive drugs due to nephrotoxicity were also significantly lower in the Campath 1H group. CONCLUSION: Campath 1H induction with low-dose Tacrolimus maintenance immunosuppression is an effective regimen in reducing acute rejection in adult liver transplantation, while maintaining lower tacrolimus levels and less nephrotoxicity than our conventional immunosuppressive regimen.

Donor and recipient pretransplant conditioning with nonlethal radiation and antilymphocyte serum improves the graft survival in a rat small bowel transplant model.

BACKGROUND: Lymphoid tissue within the intestinal graft require immunomodulatory strategies to prevent graft versus host disease (GVHD) after transplant. Herein, we evaluate the potential advantage of donor-specific bone marrow infusions in donor and or recipient preconditioned with total body irradiation and or antilymphocyte serum (ALS) on the incidence of GVHD and rejection after small bowel transplantation. METHODS: Heterotopic SBTx was performed from DA to Lewis rats and distributed in nine groups: control group G0 (n=4) and G1 (n=6) without irradiation; recipients in G2 (n=4) were given 400 rd although in groups 3 (n=5), G4 (n=6), G6 (n=5), G7 (n=5), and G8 (n=6) with 250 rd. Donors in G5 (n=4) and G6 were given 250 rd of total body irradiation 2 hours before intestinal retrieval. Donors and recipients in G7 and donors in G8 additionally received ALS (day -5). G1, 2, 3, 5, 6, 7, and 8 were infused with UDBM and G4 with the same amount of TCDBM. Animals received tacrolimus for 15 days and accessed for rejection, GVHD and for chimerism analysis. RESULTS: High mortality due to GVHD was observed in G2, 3, and 4, and correlated with high levels of donor T cells in recipients blood. G0 and G1 showed early acute rejection with progression toward chronic rejection, in contrast to the preconditioned groups. High and low doses of total body irradiation resulted in allogeneic and in a mixed chimerism, respectively. Decrease in donor chimeric cells after 11 weeks in preconditioned groups was correlated with severe allograft rejection. CONCLUSION: Donor preconditioning with 250 rd and or ALS combined with recipient preconditioning and donor-specific bone marrow infusions prevented GVHD and resulted in a transient mixed chimerism with inhibition of allograft rejection after small bowel transplantation.

Study of the development and evolution of neointestine in a rat model.

The implantation of fragmented rat intestinal epithelium into the omentum of syngeneic animals results in the formation of a cyst containing neointestine. The purpose of our project was to study the evolution of this neointestine-containing cyst over time. Harvested jejunum and ileum of neonatal DA rats (6 to 8 days old) was digested with collagenase type XI and dispase at room temperature. The resulting organoid units, containing clusters of intestinal epithelium with stem cells were seeded onto a polyglactin polymer mesh (100000 units per mesh). The absorbable mesh was implanted in the omentum or peritoneal wall of an adult syngeneic animal. Animals were sacrificed at weekly intervals to harvest the neointestinal cysts. The lumen of the neointestine cysts was full of mucous while the wall of the cyst was covered by intestinal mucosa. H&E staining of the cyst demonstrated the morphology of intestinal epithelium; PAS staining identified goblet cells. The size of the cyst was maximal between 4 and 8 weeks postimplantation tending to regress thereafter. Neointestinal cysts are a consistent finding after implantation of intestinal epithelium organoids into the omentum or peritoneal wall in the rat model. The cysts reach a maximal size at 4 to 8 weeks postimplantation, tending to regress thereafter.

Intestinal transplantation: advances in immunosuppression and surgical techniques.

Campath-1H is being used as induction immunosuppression for intestinal/multivisceral transplantation. Patient and graft survival in this preliminary experience is similar to previous studies but there has been a significant decrease in the incidence and severity of acute rejections without increase of opportunistic infections. Collage of the abdominal wall (transplantation of a composite graft of the abdominal wall) can provide biologic coverage of the newly transplanted abdominal organs if necessary. Partial abdominal exenteration, ex vivo resection, and intestinal autotransplantation may be useful in removing otherwise unresectable lesions of the root of the mesentery.

Organ donation and transplantation from medical students' perspective: introducing the experience from an academic league in Brazil.

INTRODUCTION: Medical education is an important factor to decrease the waiting list for transplantation. Reports in the medical literature reveal limited notification of potential organ donors by general physicians. Appropriate information is also needed to increase the availability of potential donors and minimize the waiting list. This article describes the acquired experience with an extracurricular program of education on organ and tissue transplantation in our institution, searching to meet medical information needs using a format of an academic league. METHODS: This qualitative study describes a proposed approach on the theme of "transplant and organ and tissue donation" with medical students from a Brazilian university, through creation of a program named "Transplantation League" in direct association with a transplantation center. RESULTS: The league's activities are based on three main activities teaching, research, and practical. Besides the organization of the I Course of Organ and Tissue Transplantation, the project received financial support from the Federal University of Goiás to develop the assignments. A member's stake in the league included scientific projects involving liver transplantation candidates, as well as notification, donation, transportation, and transplantation of these patients. CONCLUSION: The academic league has the purpose of academic information on organ and tissues transplantation. Its application in medical schools may be valuable to increase transplant numbers.

Heterotopic sternum transplant in rats: A new model of a vascularized bone marrow transplantation.

We introduced the heterotopic vascularized sternum transplant as a more simple and pure alternative to allogeneic hind limb transplantation for the study of bone marrow transplantation. We report the clinical and histopathological manifestations after transplantation of syngeneic and allogeneic sternal grafts with and without immunosuppression with FK-506. Syngeneic grafts maintained normal histology, whereas allografts showed rejection, which was prevented by FK-506. FK-506-treated allografts developed chimerism that was present throughout the observation period. Transplantation of the sternum may be a valuable model to study vascularized bone marrow transplantation and its effects on repopulation of bone marrow of the host, chimerism, and tolerance.