2011 - ISBTS 2011 Symposium


Oral Communications 6: Surgical Aspects of ITX

8.151 - Outcome of pigs with short gut syndrome submitted to orthotopic intestinal transplantation (IT)

Presenter: Alexandre, Bakonyi Neto, Botucatu, Brazil
Authors: Alexandre Bakonyi Neto1


151
Outcome of pigs with short gut syndrome submitted to orthotopic intestinal transplantation (IT)

Alexandre Bakonyi Neto

Botucatu Faculty of Medicine - Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil

Background: Many models in small animals have been described for nutritional studies, most of them without reproducing conditions observed in clinic. Herein we present the outcome of pigs submitted to a various extension of small bowel resections (SBR) and transplantation in order to achieve a reproducible model in large animals .

Method: Forty - two Landrace - Large White pigs were resected and distributed in five groups: G1(n = 6), G2(n = 6) and G3(n = 6) were submitted to 80%,100% and 100% plus right colon resection respectively and G4(n = 7) and G5(n = 5) to 100% SBR plus IT with immunosuppression (G5) based on Tacrolimus and Mycophenolic acid at a doses of 0,2 mg/kg/day and 15mg/kg/day. The level of tacrolimus was adjusted to 15-20 ng/ml. Postoperative evaluation included weekly control weight, clinical status, biochemical analysis (sodium, potassium, calcium, glycemia, urea, creatinine, triglycerides, total cholesterol, total proteins, albumin ) and Conventional endoscopies for graft biopsies.

Results: The weight increase in G1 suggesting SB adaptation and decreased in  G2 (chronically)  and G3 (acutelly ), showing inadequate adaptation after SBR. Endoscopic evaluation showed ulcerations and  flat mucosa of G4 in  57%, 71% respectively, beginning mostly after two  weeks after transplant and a normal endoscopic appearance in G5 animals. Histological studies  in G4 demonstrated moderate acute rejection after  the first week. Severe acute rejection (SAR) was observed in 1 animal in G5 at day 14, with histologically  recovery in one week. The remaining animalls in G5 (80%) showed a histological rejection classified as indeterminate. At necropsies, presence of SAR was observed in G4 and indeterminated to mild in G5.

With exception of G1, the nutritional parameters decrease significantly in G2,G3,G4,and G5. Overall survival was 12 weeks in G1 and G2, whereas in G3,G4 and G5 was 25+/- 6 days.

Conclusion: G1  did not allow a model of short bowel syndrome (SBS), whereas G2  supplied a adequate model for SBS. Inclusion of ileocecal valve to SBR not allowed survival for intestinal failure studies. IT  without immunosuppression resulted in severe rejection and the immunosuppression protocol was adequate to prevent SAR, but inadequate to increase the survival. Rejection can be identified by using conventional endoscopies  after IT.

*This research was supported by Fapesp No: 03/13490-4


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