Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Hepatobiliary Pancreat Dis Int. 2009 Aug;8(4):363-9.
A simultaneously transplanted liver shields a bowel graft from immunologic attack in small animals, while the possible immuno-tolerance induced by the liver in liver and small bowel transplantation (LSBT) is uncertain in large animal models. To investigate the clinically suspected beneficial effect of the liver on small bowel allograft, we developed a new model of composite LSBT in the pig.
Seventy outbred long-white pigs were randomized into four groups. LSBT without immunosuppressive treatment (n=10, group A); LSBT with routine immunosuppressive treatment (n=10, group B); LSBT with a lower dose of immunosuppressive treatment (n=10, group C); and small bowel segment allotransplantation without immunosuppressive treatment (n=10, group D).
There was no remarkable difference in survival time between groups A and D (10.33 vs. 12.89 days, P>0.05), but the initial time of acute rejection of the intestinal graft in group A was clearly delayed when compared to group D (8.22 vs. 4.33 days, P<0.05), and the rejection scores in group A were remarkably lower than those in group D at each postoperative time point (0 vs. 0.44 on day 3, P<0.05; 0.22 vs. 1.78 on day 5, P<0.05; 1.11 vs. 2.56 on day 7, P<0.05). There were evident differences in postoperative survival time, initial time of acute rejection and postoperative rejection scores between groups A, B and C. Postoperative survival time (30.00 vs. 28.13 days, P>0.05), initial acute rejection time (25.40 vs. 22.13 days, P>0.05) or rejection score did not differ between groups B and C within one postoperative month.
Compared to isolated segment small bowel allotransplantation, the intestinal graft in LSBT (group A) had a delayed initial time of acute rejection and a lower postoperative acute rejection score, and a lower dose of immunosuppressive treatment led to persistent graft immuno-tolerance in LSBT. Thus the simultaneously transplanted liver graft may reduce the risk of intestinal rejection and protect the bowel graft from severe acute rejection.
在小动物中，同时移植的肝脏可以保护肠移植物免受免疫攻击，而在大动物模型中，肝脏在肝和小肠移植（LSBT）中诱导的可能免疫耐受尚不确定。为了研究临床上疑似肝脏对小肠移植物有益的作用，我们在猪中开发了一种新的复合 LSBT 模型。
70 只远交长白猪随机分为四组。无免疫抑制治疗的 LSBT（n=10，A 组）；常规免疫抑制治疗的 LSBT（n=10，B 组）；低剂量免疫抑制治疗的 LSBT（n=10，C 组）；无免疫抑制治疗的小肠段同种异体移植（n=10，D 组）。
A 组和 D 组的存活时间无显著差异（10.33 天 vs. 12.89 天，P>0.05），但 A 组肠移植物急性排斥的初始时间明显延迟（8.22 天 vs. 4.33 天，P<0.05），且 A 组各术后时间点的排斥评分明显低于 D 组（术后 3 天 0 分 vs. 0.44 分，P<0.05；术后 5 天 0.22 分 vs. 1.78 分，P<0.05；术后 7 天 1.11 分 vs. 2.56 分，P<0.05）。A、B 和 C 组之间术后存活时间、急性排斥初始时间和术后排斥评分差异明显。术后存活时间（30.00 天 vs. 28.13 天，P>0.05）、急性排斥初始时间（25.40 天 vs. 22.13 天，P>0.05）或排斥评分在术后 1 个月内 B 组和 C 组之间无差异。
与单纯的小肠段同种异体移植相比，LSBT（A 组）的肠移植物急性排斥的初始时间延迟，术后急性排斥评分降低，且低剂量免疫抑制治疗可导致 LSBT 持续的移植物免疫耐受。因此，同时移植的肝移植物可能降低肠排斥的风险，并保护肠移植物免受严重急性排斥。
