von Websky Martin W, Kalff Joerg C, Schäfer Nico
Department of Surgery, University Hospital of Bonn, Bonn, Germany.
Curr Opin Organ Transplant. 2015 Jun;20(3):303-7. doi: 10.1097/MOT.0000000000000190.
Understanding the key mechanisms impacting on intestinal graft motility is paramount for successful intestinal transplantation. In this review, we will discuss causes of graft hypomotility and hypermotility, rooted in changes of the intrinsic nervous system, local inflammatory processes, adaptive immune responses, and more.
Recently, it has been shown that the gut microbiome closely interacts with the structural integrity and rejection processes in the small intestine. After the ischemia/reperfusion injury is overcome, the absence of rejection is important to maintain graft motor function. The interstitial cells of Cajal, with their pacemaker function, play an important role by regulating propulsive intestinal motility in the initial absence of extrinsic signaling. Local inflammatory and immunological changes in the tunica muscularis of transplanted intestines also result in dysmotility, both after ischemia/reperfusion and during rejection.
Motility of the transplanted intestine is crucial for transplant outcome and depends on multiple factors. Extrinsic denervation and changes in the intrinsic intestinal nervous system, local inflammation in the tunica muscularis, acute and chronic rejection, changes in the microbiome with Toll-like receptor activation, stasis of intestinal contents with bacterial translocation, all multifactorially result in impaired graft motility. These factors must be individually acknowledged and addressed to obtain adequate graft function.
了解影响肠道移植物动力的关键机制对于成功进行肠道移植至关重要。在本综述中，我们将讨论移植物动力不足和动力过强的原因，其根源在于内在神经系统的变化、局部炎症过程、适应性免疫反应等。
最近的研究表明，肠道微生物群与小肠的结构完整性和排斥反应过程密切相互作用。克服缺血/再灌注损伤后，无排斥反应对于维持移植物运动功能很重要。 Cajal间质细胞具有起搏功能，在最初缺乏外在信号时通过调节肠道推进性运动发挥重要作用。移植肠肌层的局部炎症和免疫变化在缺血/再灌注后和排斥反应期间也会导致运动障碍。
移植肠的动力对移植结果至关重要，并且取决于多种因素。外在去神经支配和肠道内在神经系统的变化、肌层局部炎症、急性和慢性排斥反应、微生物群变化伴Toll样受体激活、肠内容物淤滞伴细菌移位，所有这些多因素导致移植物动力受损。必须分别认识和处理这些因素，以获得足够的移植物功能。
