CLINICAL COURSE, MORPHOLOGY, AND TREATMENT OF CHRONICALLY REJECTING SMALL BOWEL ALLOGRAFTS
CLINICAL COURSE, MORPHOLOGY, AND TREATMENT OF CHRONICALLY REJECTING SMALL BOWEL ALLOGRAFTS
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慢性排斥小肠同种异体移植物的临床病程、形态学和治疗
DOI：
10.1097/00007890-199302000-00002
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发表时间：
1993
期刊：
影响因子：
6.2
通讯作者：
W. Schraut
中科院分区：
文献类型：
--
作者：
J. Langrehr;B. Banner;Ken K.W. Lee;W. Schraut
由于在临床器官移植中最常预防或控制急性排斥反应发作，慢性排斥反应过程已成为同种异体移植物晚期功能障碍和最终丧失的主要原因。最近关于成功的临床肠移植的报道促使我们研究急性排斥反应得到初步控制后可能出现的慢性排斥反应过程。使用强烈组织不相容的ACI→LEW大鼠品系组合和环孢素有限的初始免疫抑制治疗后的系列移植物活检，我们定义了原位小肠移植慢性排斥反应的临床和病理形态学过程。与急性排斥反应不同，肠壁（尤其是粘膜和粘膜下层）不是慢性排斥反应的主要靶点。我们观察到进行性破坏的派尔集合淋巴结和肠系膜淋巴结的移植物-一个过程中开始在4周的过程中的CsA-和渗透和破坏的移植肠系膜血管。测试免疫抑制药物FK 506和CsA改善持续慢性排斥反应的疗效，我们发现FK 506的短期疗程（5天）比CsA的第二个4周疗程更有效。
As acute rejection episodes are most frequently prevented or controlled in clinical organ transplantation, chronic rejection processes have become the major reason for late dysfunction and eventual loss of the allo-graft. The recent reports on successful clinical intestinal transplantation prompted us to investigate chronic rejection processes that may arise after the initial control of acute rejection. Using the strongly histoincompatible ACI→LEW rat strain combination and serial graft biopsies after limited initial immunosuppressive therapy with cyclosporine, we defined the clinical and pathomorphologic course of chronic rejection of orthotopic small bowel allografts. Differing from acute rejection, the bowel wall (especially the mucosa and submucosa) was not the primary target of chronic rejection. We observed progressive destruction of the Peyer's patches and the mesenteric lymph nodes of the graft—a process which began during the 4-week course of CsA—and infiltration and destruction of graft mesenteric vessels. Testing the immunosuppressive drugs FK506 and CsA for their efficacy to ameliorate ongoing chronic rejection, we found that a short course (5 days) of FK506 was more effective than a second 4-week course of CsA.