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Presenter: Claudia, Diaz, Buenos Aires, Argentina
Authors: Claudia Diaz1, Pablo Dangelo1, Daniel Alvarez1, Juan Manuel Padín2, Constanza Echevarria2, Gabriel Gondolesi2, Hector Solar Muñiz2
Claudia Diaz1, Pablo Dangelo1, Daniel Alvarez1, Juan Manuel Padín2, Constanza Echevarria2, Gabriel Gondolesi2, Hector Solar Muñiz2
1Servicio de Ecografía, Hospital Universitario Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina; 2Instituto de Trasplante Multiorganico, Unidad de Nutrición, Rehabilitación y Trasplante Intestinal, Hospital Universitario Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
Introduction: The intestinal blood flow in the unfed resting state is controlled by numerous mechanisms, being the sympathetic neurogenic input to the large blood vessels and inflow arterioles one of the most relevant. Post prandial intestinal hyperemia can be regulated by direct nutrients effects, by the enteric and central nervous system, the local gastrointestinal hormones and peptides or the local impact of metabolic and non metabolic vasoactive mediators. The aim of this study was to assess the behaviour of mesenteric blood flow in a group of long term intestinal transplant survivor patients at fast and after a mixed liquid test meal. The results were compared with a match non-transplant healthy control subjects.
Methods: After an overnight fast the mesenteric hemodynamics at fasting and in post-prandial state were assess in six adult intestinal transplant pts and compared with 6 match non-transplant healthy subjects by doppler ultrasound (US). US was done with a Envisor HD Philips®, at baseline (after a rest period of 15 minutes in supine position) follow by a repeat test at 20, 40, 60, 90 and 120 minutes after standardized meal intake (200 ml, 12 grs of proteins, 36,8 grs of carbohydrates and 11.6 grs of fat). Mean velocity (MV) and the resistive index (RI) of superior mesenteric artery (SMA) were measured. Paired sample T-T and ANOVA were used for statistical analysis using SPSS v17.0®.
Results: Non significant differences were found in baseline mesenteric hemodynamics among both groups. The most significant postprandial (PP) blood flow increase in the superior mesenteric artery was observed at 40 min in the ITx group (Table 1) while it occurred at 20 min in the match healthy control group. Similar findings were observed in the analyses of the SMA RI as shown in table 1. There was a difference between groups in the time to return to both base line values differing by 30 min between Transplant and Control group ( 90 vs 120 min) after meal intake.
Conclusions: Baseline and post prandrial mesenteric hemodynamics in ITx survivors can be adequately assess by US-doppler. A 20 minutes delay in Mesenteric flow increase after oral intake was observed in the transplant population compared with match controls, with a faster capability to return to baseline. Further early post ITx studies complemented by motility analyses will deeply proved the role of the re-innervation in the post prandrial regulation of the graft.
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