Selcuk Kilinc

Tepecik Training and Research Hospital, Izmir, Turkey

Introduction: Acute cellular rejection (ACR) occurs more frequently and severely in the small intestinal graft than in any other abdominal organ. ⁽¹⁾MSCs are able to inhibit T cell proliferation in vitro and in vivo and exert similar inhibitory effects on B, dendritic, and natural killer cells as a new stem cell therapy class for autoimmune disease, solid organ transplantation and treatment of graft-versus-host disease (GVHD). ^(2,3,4) Severe liver dysfunction and fibrosis is another problem. MSCs can produce a series of growth factors, enhance hepatocyte functionality and stimulate endogenous hepatocyte proliferation .^(5,6)

Aim: We describe three patients with intestinal failure treated by small bowel (SB) tx and MCSs andanalyze these patients’ prognosis and follow-up.

Ethics committee: Republic of Turkey Ministry of  Health permission granted.

Discussion: Property and treatment modality of cases seen in table.

The aim in all cases was for a first dose of at least 1 million/kg to be given from the transplanted organ SMA, and for a second dose to be given by catheter inserted 15 days postoperatively. The absence of rejection in Case 2 may be attributed to the different method of administration.This could not be done in two cases that died for various reasons as detailed respectively: Incompatibilities between suitable cadaver donor harvesting time and MSCs of adequate maturity being obtained ; inability to take samples containing sufficient qualification from bone marrow as a result of clinical failures in the patient due to undergo small bowel transfer ;inability to administer first dose of MSCs on day 0 postoperatively due to incompatibility in cadaveric donor and recipient blood crosses.

So we newly designed phase 2 clinical study (30 cases) and the requisite permissions have been obtained.

Table: Immunosupressive treatment and property of cases

IR:Immunosuppressive regimen, ATG: Anti thymocyte globulin,  TPN: Total parenteral nutrition

Literature:

1. A Pascher, S Kohler, P Neuhaus, J Practscke Present status and future perspective of intestinal transplantation. European Society For Org Transplantation 21(2008) 401-414
2. Zhang X, Jiao C, Zhao S Role of mesenchymal stem cells in immunological rejection of organ  transplantation. Stem Cell Rev. 2009 Dec; 5(4): 402-9
3. Popp FC, Eggenhofer E, Renner P, Slowik P, Lang SA, Kaspar H et al. Mesenchymal stem cells can induce long-term acceptance of solid organ allografts in synergy with low-dose mycophenolate Transpl Immunol. 2008 Nov; 20 (1-2): 55-60
4. English K, French A, Wood KJ Mesenchymal stromal cells: facilitators of successful transplantation?.Cell Stem Cell 2010 Oct 8; 7(4): 431-42.
5. Christ B, Dollinger MM. The generation of hepatocytes from mesenchymal stem cells and engraftment into the liver. Curr Opin Organ Transplant. 2010 Dec 9.
6.  Lin H, Xu R, Zhang Z, Chen L, Shi M, Wang FS Implications of the immunuregulatory functions of mesenchymal  stem cells in the treatment of human liver diseases. Cell Mol Immunol. 2010 Jan; 8(1): 19-22. Epub 2010 Nov 22.