Galvão Flavio H F, Waisberg Daniel R, Seid Victor E, Costa Anderson C L, Chaib Eleazar, Baptista Rachel Rossini, Capelozzi Vera Luiza, Lanchotte Cinthia, Cruz Ruy J, Araki Jun, D'Albuquerque Luiz Carneiro
Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Department of Pathology FMUSP, São Paulo, Brazil.
Sci Rep. 2016 Aug 4;6:30894. doi: 10.1038/srep30894.
Fecal incontinence is a challenging condition with numerous available treatment modalities. Success rates vary across these modalities, and permanent colostomy is often indicated when they fail. For these cases, a novel potential therapeutic strategy is anorectal transplantation (ATx). We performed four isogeneic (Lewis-to-Lewis) and seven allogeneic (Wistar-to-Lewis) ATx procedures. The anorectum was retrieved with a vascular pedicle containing the aorta in continuity with the inferior mesenteric artery and portal vein in continuity with the inferior mesenteric vein. In the recipient, the native anorectal segment was removed and the graft was transplanted by end-to-side aorta-aorta and porto-cava anastomoses and end-to-end colorectal anastomosis. Recipients were sacrificed at the experimental endpoint on postoperative day 30. Surviving animals resumed normal body weight gain and clinical performance within 5 days of surgery. Isografts and 42.9% of allografts achieved normal clinical evolution up to the experimental endpoint. In 57.1% of allografts, signs of immunological rejection (abdominal distention, diarrhea, and anal mucosa inflammation) were observed three weeks after transplantation. Histology revealed moderate to severe rejection in allografts and no signs of rejection in isografts. We describe a feasible model of ATx in rats, which may allow further physiological and immunologic studies.
大便失禁是一种具有多种可用治疗方式的挑战性疾病。这些治疗方式的成功率各不相同，当治疗失败时通常会进行永久性结肠造口术。对于这些病例，一种新的潜在治疗策略是肛门直肠移植（ATx）。我们进行了4例同基因（Lewis到Lewis）和7例异基因（Wistar到Lewis）的ATx手术。肛门直肠连同包含与肠系膜下动脉连续的主动脉的血管蒂以及与肠系膜下静脉连续的门静脉一起被取出。在受体中，切除天然肛门直肠段，并通过端侧主动脉-主动脉吻合、门静脉-腔静脉吻合以及端端结肠直肠吻合来移植移植物。在术后第30天的实验终点处死受体。存活的动物在手术后5天内恢复了正常的体重增加和临床表现。同基因移植物和42.9%的异基因移植物在实验终点前实现了正常的临床进展。在57.1%的异基因移植物中，移植后三周观察到免疫排斥迹象（腹胀、腹泻和肛门黏膜炎症）。组织学检查显示异基因移植物有中度至重度排斥反应，同基因移植物无排斥迹象。我们描述了一种大鼠ATx的可行模型，这可能有助于进一步的生理学和免疫学研究。
