Raofi V, Fontaine M J, Mihalov M L, Holman D M, Dunn T B, Vitello J M, Asolati M, Kumins N H, Benedetti E
Department of Surgery, University of Illinois at Chicago, 60612, USA.
Transplantation. 1999 Jul 27;68(2):188-91. doi: 10.1097/00007890-199907270-00004.
The optimal biopsy site of bowel allografts for rejection surveillance remains controversial. We compared the results of jejunal (JBx) and ileal (IBx) biopsies after bowel transplantation in a porcine model.
Eighteen Yorkshire-Landrace pigs served as donors. Eighteen recipient pigs underwent total enterectomy followed by orthotopic small bowel transplantation with or without the colon. A jejunostomy and a Bishop-Koop ileostomy were constructed for biopsies. Immunosuppression consisted of FK506 (target level 10-15 ng/ml by enzyme immunoparticle assay) and prednisone administered via the jejunostomy. Simultaneous JBx and IBx were performed twice weekly. Acute rejection was graded as mild, moderate, or severe based on previously published criteria.
Mean overall survival after the transplant was 17.4 days. A total of 162 specimens were collected and evaluated for rejection (JBx, 81; IBx, 81). Acute rejection was detected in 41 JBx cases (50.7%) and 40 IBx cases (49.4%). The presence or absence of rejection was concordant between JBx and IBx in 70 of 81 case pairs (86.4%). Of the 11 discordant case pairs, 6 were JBx positive/IBx negative, whereas 5 were JBx negative/IBx positive. A total of 35 case pairs were synchronously positive, 24 (68.8%) of which demonstrated the same degree of rejection.
The correlation between JBx and IBx of bowel allografts in diagnosing the presence of acute rejection is quite good. However, performing IBx alone would have missed about 7.5% of the rejection episodes. Because the early treatment of rejection in bowel transplantation is of paramount importance, in selected cases, biopsies from both the ileum and jejunum should be considered if technically feasible.
用于排斥反应监测的肠移植最佳活检部位仍存在争议。我们在猪模型中比较了肠移植后空肠活检（JBx）和回肠活检（IBx）的结果。
18头约克夏-长白猪作为供体。18头受体猪接受全肠切除术，然后进行原位小肠移植，可选择带或不带结肠。构建空肠造口术和毕晓普-库普回肠造口术用于活检。免疫抑制方案包括通过空肠造口术给予FK506（酶免疫颗粒分析法目标水平为10 - 15 ng/ml）和泼尼松。每周进行两次同步JBx和IBx。根据先前公布的标准，将急性排斥反应分为轻度、中度或重度。
移植后的平均总生存期为17.4天。共收集162份标本并评估排斥反应（JBx，81份；IBx，81份）。在41例JBx病例（50.7%）和40例IBx病例（49.4%）中检测到急性排斥反应。81对病例中，70对（86.4%）JBx和IBx的排斥反应情况一致。在11对不一致的病例中，6对为JBx阳性/IBx阴性，而5对为JBx阴性/IBx阳性。共有35对病例同步呈阳性，其中24对（68.8%）表现出相同程度的排斥反应。
肠移植中JBx和IBx在诊断急性排斥反应方面的相关性相当好。然而，仅进行IBx会漏诊约7.5%的排斥反应事件。由于肠移植中排斥反应的早期治疗至关重要，在某些选定病例中，如果技术可行，应考虑同时进行回肠和空肠活检。
