The motor behavior of the graft and the native gastrointestinal segment in humans with small bowel transplant
Claudio R Bilder2, AndrÃ©s Ditaranto2, Fabio Nachman2, Leonel Rodriguez3, Hector Solar Muniz1, Constanza Echevarria1, Carolina Rumbo1, Eduardo Mauricio2, Gabriel Eduardo Gondolesi1
1Multiorgan Transplant Institute, Favaloro's Foundation University Hospital, Ciudad Autonoma de Buenos Aires, Argentina; 2Gastroenterology Lab, Favaloro's Foundation University Hospital, Ciudad Autonoma de Buenos Aires, Argentina; 3 Center for Motility and Functional Gastrointestinal Disorders,Gastroenterology, Boston ChildrenÂ´s Hospital, Harvard Medical School, Boston, MA, United States
In humans,two specific motility patterns are coordinated within the enteric nervous system(ENS): 1-the interdigestive motor cycle(IDMC) and its migrating motor complex(MMC) ,2-the postprandial motility pattern. The IDMC and the MMC continue in the small bowel after a vagotomy or a sympathectomy but stop when they reach a region of the intestine where the ENS has been interrupted. This phenomenon, together with an extrinsic denervation occur after a small bowel transplant (SBT), the impact of these disruptive changes in humans are unknown. Aim: to evaluate the motor activities of the graft and the native gastro-intestinal segment (previously undescribed process).
Patients & methods
1-Female(60),intestinal failure (IF)after mesenteric ischemia in a ulcerative jejunitis secondary to celiac disease.SBT:10/20/2010.Motility study:10/24/2011.Recording duration:6hrs
2-Male(21), IF post mesenteric artery lesion(blunt abdominal trauma).SBT:8/8/2011.Motility study:12/19/2011.Recording duration:7hrs.
Patients were intubated with a multilumen assembly,two proximal openings in antrum,three in duodenum-jejunum,the last three were in the graft.Recording lumens were perfused with water(0,2 ml/min) by a low-compliance pneumohydraulic infusion system.
Results: see table,motility index(MI) refers to phase II(IDMC) phasic activity.
Fifteen MMCs migrated within the native segment(image 1A),four MMCs starting in the native antrum propagated into the graft(image 1B).
As in the fasting period(MI p<0,04),after 500 kcal meal,the graft activity tends to be lower than in native segment.
-The IDMC phases were identified in both segments.
-MMC starting in the native antrum migrated in a coordinated manner along the graft.
- At least four months after SBT, patients showed reinnervation signs expressed by the MMC normal propagation and a subtle graft fed pattern.