Bernstein C N
Dept. of Medicine, University of Manitoba, Winnipeg, Canada.
Scand J Gastroenterol Suppl. 1995;208:118-24. doi: 10.3109/00365529509107772.
The small bowel, the largest lymphoid organ in the body and host to a myriad of foreign antigens has presented a formidable challenge for transplantation. In the past 5 years, small bowel transplantation has become a viable clinical entity. Successful transplantation of the small bowel has been achieved as part of multivisceral grafting, combined small bowel and liver grafts and even as isolated small bowel grafts. Allograft rejection remains an important post-transplantation problem, although graft versus host disease has been less of a clinical problem than initially feared. Markers that may serve to predict early rejection have been identified and include: assessment of endoscopic biopsies for enterocyte Class II antigen expression and for mucosal T cell and macrophage infiltration, bowel permeability studies, and measurement of changes in transepithelial potential difference. Earlier detection of rejection and more potent therapy for rejection episodes will be necessary to further improve outcomes.
小肠作为体内最大的淋巴器官，承载着无数外来抗原，这给小肠移植带来了巨大挑战。在过去5年中，小肠移植已成为一种可行的临床治疗手段。小肠移植已成功应用于多脏器移植、小肠与肝脏联合移植，甚至单独的小肠移植。尽管移植物抗宿主病并不像最初担心的那样成为严重的临床问题，但同种异体移植物排斥反应仍是移植后的一个重要问题。已确定了一些可能用于预测早期排斥反应的指标，包括：评估内镜活检中肠上皮细胞II类抗原的表达以及黏膜T细胞和巨噬细胞的浸润情况、肠道通透性研究以及测量跨上皮电位差的变化。为进一步改善治疗效果，有必要更早地检测排斥反应并对排斥反应发作进行更有效的治疗。
