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Crismale JF, Mahmoud D, Moon J, Fiel MI, Iyer K, Schiano TD. The role of endoscopy in the small intestinal transplant recipient: A review. Am J Transplant 2021; 21:1705-1712. [PMID: 33043624 DOI: 10.1111/ajt.16354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023]
Abstract
Intestinal transplantation (ITx) is the treatment of choice for patients with intestinal failure who have developed life-threatening complications related to long-term parenteral nutrition. Patients may also undergo ITx as part of a combined liver-intestine or multivisceral transplant for a variety of indications, most commonly intestinal failure-associated liver disease or porto-mesenteric thrombosis. Endoscopy plays a critical role in the posttransplant management of these patients, most commonly in the diagnosis and management of rejection, which occurs in up to 30-40% of patients within the first-year posttransplant. With a lack of noninvasive biomarkers to identify the presence of rejection, endoscopy and biopsy remain the gold standard for its diagnosis. Endoscopic evaluation of the graft is also important in the identification of other complications post-ITx, including posttransplant lymphoproliferative disorder, graft-versus-host disease, and enteric infections. Each patient's posttransplant anatomy may be slightly different, making endoscopy sometimes technically challenging and necessitating clear and frequent communication with the surgical team in order to help identify the highest yield approach. Herein, we review the most common pathologies found endoscopically in the post-ITx patient and describe some of the unique challenges the endoscopist faces when evaluating these complex patients.
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Affiliation(s)
- James F Crismale
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA
| | - Dalia Mahmoud
- Atlantic Digestive Specialists, Wentworth-Douglass Hospital, Portsmouth, New Hampshire, USA
| | - Jang Moon
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA
| | - M Isabel Fiel
- Department of Pathology and Laboratory Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Kishore Iyer
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA
| | - Thomas D Schiano
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA
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2
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Cruz RJ, Poloyac K, Roberts M, Stein W, Humar A. Safe Use of Erythromycin For Refractory Gastroparesis After Small Bowel Transplantation. EXP CLIN TRANSPLANT 2021; 20:224-227. [PMID: 33877033 DOI: 10.6002/ect.2020.0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Current therapeutic options with prokinetic agents for posttransplant gastroparesis are limited. Erythromycin is associated with adverse reactions, including corrected QT interval prolongation and cytochrome P450 3A4 isoenzyme inhibition. The use of erythromycin has been avoided in patients undergoing treatment with cyclosporine or tacrolimus because of significant fluctuations in therapeutic immunosuppression levels. We report herein the successful use of erythromycin after visceral transplant to treat delayed gastric emptying. Two patients were managed with oral erythromycin (initial dose of 750 mg/d divided into 3 doses) for gastroparesis after visceral transplant. Patient 1 was a woman aged 42 years with a history of chronic intestinal pseudo-obstruction syndrome who underwent isolated small bowel transplant with dual (gastric and duodenal) proximal allograft anastomosis. Posttransplant gastroparesis was initially managed with oral metoclopramide. The patient also required high doses of tacrolimus (36 mg/d) to maintain adequate immunosuppression levels. The decision was made to change metoclopramide to erythromycin, which significantly decreased the daily tacrolimus dose requirement (from 36 to 9 mg/d), with resolution of nausea and intermittent bloating symptoms. Patient 2 was a woman aged 35 years with ultra-short gut syndrome after extensive enterectomy due to intestinal volvulus who underwent uneventful combined intestinal and colon transplant. Conventional pharmacologic therapy for gastroparesis was initiated after surgery without success. Erythromycin was started 15 days posttransplant, with significant improvement in her symptoms, and discontinued 47 days post-transplant. To maintain therapeutic levels (8-10 mg/dL), daily tacrolimus dose was decreased 75.8% and 36.5% for patients 1 and 2, respectively. No significant side effects associated with erythromycin use were observed in either patient. Our findings here suggest that erythromycin may be safely used for gastroparesis after small bowel transplant. Close monitoring of immunosuppressive drug levels and dose adjustments of other medications affected by inhibition of cytochrome P450 3A4 are advised.
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Affiliation(s)
- Ruy J Cruz
- From the the Intestinal Rehabilitation and Transplant Center, Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,From the Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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3
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Courbage S, Canioni D, Talbotec C, Lambe C, Chardot C, Rabant M, Galmiche L, Corcos O, Goulet O, Joly F, Lacaille F. Beyond 10 years, with or without an intestinal graft: Present and future? Am J Transplant 2020; 20:2802-2812. [PMID: 32277553 DOI: 10.1111/ajt.15899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 01/25/2023]
Abstract
Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m2 . Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.
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Affiliation(s)
- Sophie Courbage
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Danielle Canioni
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Cécile Talbotec
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Cécile Lambe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Louise Galmiche
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Olivier Corcos
- Department of Gastroenterology, Nutrition Support and Intestinal Transplantation, Beaujon Hospital, University of Paris, Clichy, France
| | - Olivier Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Francisca Joly
- Department of Gastroenterology, Nutrition Support and Intestinal Transplantation, Beaujon Hospital, University of Paris, Clichy, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
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4
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Kushch MM, Kushch LL, Fesenko IA, Miroshnikova OS, Matsenko OV. Microscopic features of lamina muscularis mucosae of the goose gut. REGULATORY MECHANISMS IN BIOSYSTEMS 2019. [DOI: 10.15421/021957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of work was to determine the features of the microscopic structure of the lamina muscularis mucosae of the goose gut during the postnatal ontogenesis. According to the review of the literature, during the characterisation of the structure of the intestinal mucosa, researchers first pay attention to the condition of the villi, crypts, epithelial layer and their morphometric parameters, leaving the lamina muscularis mucosae aside. The intestinal lamina muscularis mucosae is an under-researched structure of the intestinal wall, the information on which is fragmentary and contradictory. The middle parts of the duodenum, jejunum, ileum, cecum and rectum of large grey geese of 13 age groups were investigated. The classic histological methods of staining by hematoxylin and eosin, aniline blue – orange (by Mallory), as well as azure II – eosin were used. It was established that the lamina muscularis mucosae of the goose’s small intestine is formed by two layers of unstriated muscle tissue: internal and external. In contradistinction to mammals, the thicker inner layer of the LMM has not a circular, but a longitudinal direction of cell location while by contrast the thinner outer layer is located in a circular direction. According to results of our research, the thickness of the lamina muscularis mucosae of the small intestine of the geese rapidly increased with age. The thickness of the duodenum corresponded to the value of adult geese at 60 days of age; jejunum, ileum, and rectum – at 21 days, cecum – at 7 days age. The lamina muscularis mucosae was thinnest in the duodenum, and it was thickest in the ileum. The lamina muscularis mucosa of the large intestine of geese is represented by only one longitudinal layer. By contrast, the thinner outer layer is located in a circular direction. Detailed information of the microscopic structure of the lamina muscularis mucosae of the intestine of geese can be useful for specialists, both morphologists and physiologists, for analyzing the histological preparations of the intestine of birds by the action of biotic and abiotic factors, as well as a basis of comparison with such structure in other species of animals. The description of the construction of this important microscopic structure of the intestine can serve a morphological basis for elucidating its function.
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5
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Natural killer T cell ligand alpha-galactosylceramide protects against gut ischemia reperfusion-induced organ injury in mice. Cytokine 2018; 111:237-245. [DOI: 10.1016/j.cyto.2018.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 12/21/2022]
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Nadatani Y, Watanabe T, Shimada S, Otani K, Tanigawa T, Fujiwara Y. Microbiome and intestinal ischemia/reperfusion injury. J Clin Biochem Nutr 2018; 63:26-32. [PMID: 30087540 PMCID: PMC6064812 DOI: 10.3164/jcbn.17-137] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/22/2018] [Indexed: 12/12/2022] Open
Abstract
Intestinal ischemia/reperfusion injury is a severe disease associated with a high mortality. The mechanisms that cause ischemia/reperfusion injury are complex and many factors are involved in the injury formation process; however, the only available treatment is surgical intervention. Recent studies demonstrated that the intestinal microbiome plays a key role in intestinal ischemia/reperfusion injury and there are many factors associated with intestinal bacteria during the formation of the intestinal ischemia/reperfusion injury. Among the Toll-like receptors (TLR), TLR2, TLR4, and their adaptor protein, myeloid differentiation primary-response 88 (MyD88), have been reported to be involved in intestinal ischemia/reperfusion injury. Oxidative stress and nitric oxide are also associated with intestinal bacteria during the formation of the intestinal ischemia/reperfusion injury. This review focuses on our current understanding of the impact of the microbiome, including the roles of the TLRs, oxidative stress, and nitric oxide, on intestinal ischemia/reperfusion injury.
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Affiliation(s)
- Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
| | - Sunao Shimada
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka 545-8585, Japan
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7
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Ren X, Li M, Zhao X, Liu Z, Ren S, Zhang Y, Zhang S, Canavero S. First cephalosomatic anastomosis in a human model. Surg Neurol Int 2017; 8:276. [PMID: 29279793 PMCID: PMC5705925 DOI: 10.4103/sni.sni_415_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Cephalosomatic anastomosis (CSA) has never been attempted before in man as the transected spinal cords of the body donor and body recipient could not be “fused” back together. Recent advances made this possible. Here, we report on the surgical steps necessary to reconnect a head to a body at the cervical level. Methods: Full rehearsal of a CSA on two recently deceased human cadavers was performed at Harbin Medical University, Harbin, China. Results: The surgery took 18 hours to complete within the time frame planned for this surgery. Several advances resulted from this rehearsal, including optimization of the surgical steps, sparing of the main nerves (phrenics, recurrent laryngeal nerves), and assessment of vertebral stabilization. Conclusion: Several specialties are involved in a full-scale CSA, including neck surgery, vascular surgery, orthopedic surgery, plastic surgery, gastrointestinal surgery, and neurosurgery, as well as the operating staff. This rehearsal confirmed the surgical feasibility of a human CSA and further validated the surgical plan. Education and coordination of all the operating teams and coordination of the operative staff was achieved in preparation for the live human CSA.
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Affiliation(s)
- Xiaoping Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China.,Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA
| | - Ming Li
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Xin Zhao
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Zehan Liu
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Shuai Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Yafang Zhang
- Department of Anatomy, Harbin Medical University, Harbin, China
| | - Shide Zhang
- Department of Radiology, 2 Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Sergio Canavero
- Turin Advanced Neuromodulation Group, Turin, Italy, Harbin Medical University, Harbin, China
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8
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Gürkan A. Advances in small bowel transplantation. Turk J Surg 2017; 33:135-141. [PMID: 28944322 DOI: 10.5152/turkjsurg.2017.3544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
Small bowel transplantation is a life-saving surgery for patients with intestinal failure. The biggest problem in intestinal transplantation is graft rejection. Graft rejection is the main reason for morbidity and mortality. Rejection has a negative effect on the survival of the graft. While 50%-75% of small bowel transplantation patients experience acute rejection, chronic rejection occurs in approximately 15% of patients. Immune monitoring is crucial after small bowel transplantation. Unlike other types of transplantation, there are no non-invasive or reliable markers to predict rejection in small bowel transplantation. The diagnosis of AR is confirmed by clinical symptoms, endoscopic appearance, and pathological specimens taken by endoscopy. Thus, histopathological examinations obtained by protocol biopsies remain as the gold standard for intestinal graft monitoring; however, biopsies have some complications, especially in small grafts. In addition to the high complication rate, biopsies are non-diagnostic; thus, multiple biopsies should be performed to exclude rejection. Therefore, auxiliary assays, such as measurements of citrulline and calprotectin in the blood, cytofluorographic examination of peripheral blood immune cells, cytokine profiling, and distinct gene-set-change measurements, are increasingly being used in small bowel transplantation. Developments in the understanding of genes seem to be promising that limited gene sets, taken from blood or from intestinal biopsies, will enhance pathological diagnosis. Bone marrow mesenchymal stem cell transplantation with SBT and tissue engineering are also promising procedures.
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Affiliation(s)
- Alp Gürkan
- Department of General Surgery, Çamlıca Medicana Hospital, İstanbul, Turkey.,Department of General Surgery, İstanbul Aydın University School of Medicine, İstanbul, Turkey
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9
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Oltean M, Jiga L, Hellström M, Söfteland J, Papurica M, Hoinoiu T, Ionac M, Casselbrant A. A sequential assessment of the preservation injury in porcine intestines. J Surg Res 2017; 216:149-157. [PMID: 28807200 DOI: 10.1016/j.jss.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/20/2017] [Accepted: 05/01/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinical and experimental evidence strongly suggest that ischemia-reperfusion injury after intestinal transplantation has deleterious short- and long-term effects and finding means to reduce ischemia-reperfusion injury is a major research area. The anatomical and physiological similarities between the human and porcine digestive tract favor its use as a preclinical model for translational research. Intriguingly, no systematic appraisal of the development of the intestinal preservation injury in pigs is available. MATERIALS AND METHODS Intestinal procurement was performed in nine pigs using histidine-tryptophan-ketoglutarate solution as preservation fluid. Ileal biopsies were obtained after 8, 14, and 24 h of static cold storage (SCS), and the preservation injury was assessed morphologically (Chiu score) as well as on the molecular level. Tight junction (zonula occludens, claudin-3 and 4, tricellulin, and occludin) and adherens junctions (E-cadherin) proteins were studied using immunofluorescence and Western blot. RESULTS Eight hours of SCS induced minimal mucosal changes (Chiu grade 1) that advanced to significant subepithelial edema (Chiu grade 3) after 24 h; progressive Goblet cell depletion was also noted. Apoptosis (studied by cleaved caspase-3 staining significantly increased after 24 h of SCS. Significant molecular changes with decreasing expression of zonula occludens, tricellulin, and occludin were evident already after 8 h of SCS and continuously worsened. Claudin-3 and Claudin-4 and E-cadherin expression remained relatively unaltered during SCS. CONCLUSIONS Important molecular alterations precede histologic changes during SCS of the porcine intestine and may be used as more sensitive injury markers than histologic changes in intestinal ischemia and transplantation.
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Affiliation(s)
- Mihai Oltean
- Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, University of Medicine and Pharmacy, Timisoara, Romania; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Lucian Jiga
- Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, University of Medicine and Pharmacy, Timisoara, Romania; Department for Plastic, Reconstructive, Aesthetic and Hand Surgery, Evangelisches Krankenhaus, Medical Campus, University of Oldenburg, Oldenburg, Germany
| | - Mats Hellström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - John Söfteland
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marius Papurica
- Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, University of Medicine and Pharmacy, Timisoara, Romania
| | - Teodora Hoinoiu
- Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai Ionac
- Pius Branzeu Center for Laparoscopic Surgery and Microsurgery, University of Medicine and Pharmacy, Timisoara, Romania
| | - Anna Casselbrant
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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10
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Florescu DF, Sonderup JL, Grant W, Chong PP, van Duin D, Kalil AC. Clinical presentation and outcomes of norovirus infection in intestinal allograft compared to native intestine. Transpl Infect Dis 2017; 19. [PMID: 28273399 DOI: 10.1111/tid.12692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/24/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND No data are available on clinical manifestations and course of norovirus gastroenteritis (NVE) in intestinal allograft (from intestinal and multivisceral transplant recipients, ITR) compared to native intestine (from other allograft recipients, nITR). METHODS This was a retrospective study of solid organ transplant recipients with NVE at two centers from January 1, 2010 to April 1, 2014. Chi-square, t-test, linear and logistic regression analyses were done to compare NVE in ITR vs nITR patients. RESULTS The ITR (45 patients) were compared to nITR (107 patients). ITR were younger (odds ratio [OR]=0.90; P<.0001), less likely to receive anti-lymphocyte induction therapy (OR=0.15; P<.0001), and had shorter time from transplant to NVE (OR=0.99; P=.008). On presentation ITR had less frequent nausea (OR=0.11; P<.0001) or vomiting (OR=0.36; P=.01), higher white blood cell count (OR=1.09; P=.001), and higher glomerular filtration rate (OR=1.02; P<.0001). ITR were less likely to receive anti-motility agents (OR=9.6; P<.0001). ITR were more likely to stay longer on intravenous (IV) fluids (OR=1.18; P<.0001); have recurrent NVE (OR=4.25; P<.0001); have longer hospital stay (OR=1.07; P<.0001); develop acute rejection (OR=5.1; P=.006); and have lower overall survival (OR=0.28; P=.006). CONCLUSIONS Compared to nITR, the ITR with NVE were significantly younger, had less nausea and vomiting at presentation, received less anti-motility agents, required more IV fluids, and had longer hospital stay. A trend was seen for lower survival with NVE in ITR.
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Affiliation(s)
- Diana F Florescu
- Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA.,Transplant Surgery Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jessica L Sonderup
- Internal Medicine Department, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wendy Grant
- Transplant Surgery Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Pearlie P Chong
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andre C Kalil
- Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
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11
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Bi W, Bi Y, Gao X, Li P, Hou S, Zhang Y, Bammert C, Jockusch S, Legalley TD, Michael Gibson K, Bi L. Indole-TEMPO conjugates alleviate ischemia-reperfusion injury via attenuation of oxidative stress and preservation of mitochondrial function. Bioorg Med Chem 2017; 25:2545-2568. [PMID: 28359673 DOI: 10.1016/j.bmc.2017.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 01/13/2023]
Abstract
Mitochondrial oxidative damage contributes to a wide range of pathologies including ischemia/reperfusion injury. Accordingly, protecting mitochondria from oxidative damage should possess therapeutic relevance. In the present study, we have designed and synthesized a series of novel indole-TEMPO conjugates that manifested good anti-inflammatory properties in a murine model of xylene-induced ear edema. We have demonstrated that these compounds can protect cells from simulated ischemia/reperfusion (s-I/R)-induced reactive oxygen species (ROS) overproduction and mitochondrial dysfunction. Furthermore, we have demonstrated that indole-TEMPO conjugates can attenuate organ damage induced in rodents via intestinal I/R injury. We therefore propose that the pharmacological profile and mechanism of action of these indole-TEMPO conjugates involve convergent roles, including the ability to decrease free radical production via lipid peroxidation which couples to an associated decrease in ROS-mediated activation of the inflammatory process. We further hypothesize that the protective effects of indole-TEMPO conjugates partially reside in maintaining optimal mitochondrial function.
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Affiliation(s)
- Wei Bi
- Second Hospital of HeBei Medical University, Shijiazhuang 050000, PR China.
| | - Yue Bi
- Second Hospital of HeBei Medical University, Shijiazhuang 050000, PR China
| | - Xiang Gao
- Department of Chemistry and Biological Sciences, Michigan Technological University, Houghton, MI 49931, USA
| | - Pengfei Li
- Second Hospital of HeBei Medical University, Shijiazhuang 050000, PR China
| | - Shanshan Hou
- Department of Chemistry and Biological Sciences, Michigan Technological University, Houghton, MI 49931, USA
| | - Yanrong Zhang
- Second Hospital of HeBei Medical University, Shijiazhuang 050000, PR China
| | - Cathy Bammert
- Department of Chemistry and Biological Sciences, Michigan Technological University, Houghton, MI 49931, USA
| | - Steffen Jockusch
- Department of Chemistry, Columbia University, New York, NY 10027, USA
| | - Thomas D Legalley
- Marquette General Heart and Vascular Institute, Marquette General Hospital, Marquette, MI 49855, USA
| | - K Michael Gibson
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane WA 99202, USA.
| | - Lanrong Bi
- Department of Chemistry and Biological Sciences, Michigan Technological University, Houghton, MI 49931, USA.
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12
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Shen XF, Jiang JP, Yang JJ, Wang WZ, Guan WX, Du JF. Donor-Specific Regulatory T Cells Acquired from Tolerant Mice Bearing Cardiac Allograft Promote Mixed Chimerism and Prolong Intestinal Allograft Survival. Front Immunol 2016; 7:511. [PMID: 27909438 PMCID: PMC5113131 DOI: 10.3389/fimmu.2016.00511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022] Open
Abstract
The induction of donor-specific transplant tolerance has always been a central problem for small bowel transplantation (SBT), which is thought to be the best therapy for end-stage bowel failure. With the development of new tolerance-inducing strategies, mixed chimerism induced by co-stimulation blockade has become most potent for tolerance of allografts, such as skin, kidney, and heart. However, a lack of clinically available co-stimulation blockers has hindered efficient application in humans. Furthermore, unlike those for other types of solid organ transplantation, strategies to induce robust mixed chimerism for intestinal allografts have not been fully developed. To improve current mixed chimerism induction protocols for future clinical application, we developed a new protocol using donor-specific regulatory T (Treg) cells from mice with heart allograft tolerance, immunosuppressive drugs which could be used clinically and low doses of irradiation. Our results demonstrated that donor-specific Treg cells acquired from tolerant mice after in vitro expansion generate stable chimerism and lead to acceptance of intestinal allograft. Increased intragraft Treg cells and clonal deletion contribute to the development of SBT tolerance.
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Affiliation(s)
- Xiao-Fei Shen
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School , Nanjing , China
| | - Jin-Peng Jiang
- Department of Rehabilitation Medicine, PLA Army General Hospital , Beijing , China
| | - Jian-Jun Yang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University , Xi'an , China
| | - Wei-Zhong Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University , Xi'an , China
| | - Wen-Xian Guan
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School , Nanjing , China
| | - Jun-Feng Du
- Department of General Surgery, PLA Army General Hospital , Beijing , China
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Risks and Epidemiology of Infections After Intestinal Transplantation. TRANSPLANT INFECTIONS 2016. [PMCID: PMC7123248 DOI: 10.1007/978-3-319-28797-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Intestinal transplantation has become a well-accepted and successful procedure to save the lives of patients suffering from intestinal failure and who have developed life-threatening complications of parenteral nutrition. Advances in all aspects of care, from the role of multidisciplinary intestinal rehabilitation services prior to transplant to the development strategies for early recognition of infectious sequelae and even the increasing availability of preventive strategies, have led to improved outcomes and a dramatic decline in infection-associated morbidity and mortality in children undergoing intestinal transplantation. Improvements in surgical techniques and immunosuppressive regimens have been essential components in these improvements, reducing risk of infection through reduction of technical complications and more optimal immunosuppression regimens. In addition, the development of molecular tools for early recognition of viral pathogens and an understanding of the timing and risks for infection have allowed for earlier and more successful treatments. Despite these improvements, infectious sequelae remain an important problem in this population, and additional efforts are needed to further minimize the risk of infectious sequelae in those children requiring this procedure.
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