Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Colon transplantation has been proposed as a method to improve the function of an intestinal allograft. The present study examined the risk of colon rejection and the effect of FK506 on colon rejection in BN-->LEW rats with orthotopic bowel transplants. The first 4 groups included rats with untreated allografts (group 1), rats with isografts treated with 0.6 mg/kg FK506 (group 2), rats with allografts treated with 0.6 mg/kg FK506 (group 3), and rats with allografts treated with 0.4 mg/kg FK506 (group 4). In each of these groups (10-12 rats), half of the animals received a small bowel graft only (SB), while the other half received a small bowel, ascending colon, and cecum graft (SBC). The animals were followed daily until they died or were killed at 4 weeks. In group 5, an additional 18 untreated rats with SBC allografts were randomly killed on the third, fifth, seventh, and tenth postoperative days to study the sequential histopathologic and immunopathologic changes of colon rejection. There was no difference in survival, body weight, nutritional parameters, or bacterial contamination after SB and SBC transplantation. Intestinal transit was slower after SBC than SB transplantation (P < 0.05). Sequential histopathologic studies revealed that (1) the severity and time course of colon rejection was similar to small intestine rejection, and (2) the features of colon rejection were similar to ulcerative colitis. There was no evidence of graft-versus-host disease after SBC transplantation. In summary, adding a segment of large bowel to a small bowel allograft does not increase the risk of rejection or surgical complications. The transplanted colon slows intestinal transit. Treatment with FK506 effectively prevents colon rejection. These data suggest that adding a colon graft may improve the outcome of clinical small bowel transplantation.
 ...
PMID:Treatment with FK506 prevents rejection of rat colon allografts. 751 86

Intestinal transplantation is gradually becoming a therapeutic intervention rather than an experimental procedure. In the long term, the best outcome for patients with intestinal failure remains total parenteral nutrition, but where this is unlikely to allow long-term survival because of loss of venous access sites or severe cholestasis, intestinal transplantation should be considered. The technical aspects of the procedure are well described and advances in recent years in both immunosuppression and antimicrobial therapy have led to improved outcomes, particularly in the larger centers. Graft monitoring and the profound sepsis that accompanies graft dysfunction due to bacterial translocation remain major challenges, whereas the issues of denervation, lymphatic disruption, graft-versus-host disease (GVHD), and nonphysiological venous drainage have not proved to be major problems. Whether intestinal transplantation will become an alternative for the stable patient on total parenteral nutrition rather than a salvage procedure for when total parenteral nutrition fails remains to be seen.
Clin Colon Rectal Surg 2004 May
PMID:Small bowel transplantation. 2001 Dec 56