Abu-Elmagd K, Todo S, Tzakis A, Furukawa H, Nour B, Reyes J, Nakamura K, Scotti-Foglieni C, el-Hammadi H, Kadry Z
Pittsburgh Transplantation Institute, PA 15213.
Transplant Proc. 1994 Jun;26(3):1430-1.
The current results of the present series demonstrate that intestinal allografts are more vulnerable to rejection and continue to be at a significantly higher risk long after transplantation compared with isolated liver allograft recipients. Unexpectedly, a combined liver allograft does not protect small bowel from rejection. The necessarily continuous heavy immunosuppression for these unique recipients is potentially self-defeating. This is clearly demonstrated by their high susceptibility to early and late infectious complications after transplantation as reported in this issue. With the minimal graft-versus-host disease threat in this clinical trial, our revised protocol for future intestinal transplantation is to maximize the passenger leukocyte traffic with supplementary bone marrow from the same intestinal donor in an attempt to augment the development of systemic chimerism and the gradual induction of donor-specific nonreactivity.
本系列目前的结果表明，与单纯肝移植受者相比，肠道同种异体移植更容易发生排斥反应，并且在移植后很长时间内仍面临显著更高的风险。出乎意料的是，联合肝移植并不能保护小肠免受排斥。对于这些特殊的受者而言，持续进行的高强度免疫抑制可能会适得其反。正如本期所报道的，他们在移植后对早期和晚期感染并发症高度易感，这清楚地证明了这一点。鉴于在该临床试验中移植物抗宿主病威胁极小，我们修订后的未来肠道移植方案是，通过补充来自同一肠道供体的骨髓，使过客白细胞流量最大化，以试图增强全身嵌合体的形成，并逐步诱导供体特异性无反应性。
