Monitoring of the intestinal mucosal perfusion using laser Doppler flowmetry after multivisceral transplantation
Monitoring of the intestinal mucosal perfusion using laser Doppler flowmetry after multivisceral transplantation
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DOI：
10.1016/j.transproceed.2005.09.032
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发表时间：
2005-10-01
影响因子：
0.9
通讯作者：
Herlenius, G
中科院分区：
文献类型：
--
作者：
Oltean, M;Aneman, A;Herlenius, G
背景移植物内皮是急性排斥反应的主要靶点。T细胞、单核细胞的浸润和增强的内皮-白细胞相互作用导致微血管损伤和灌注改变。我们用激光多普勒血流计测量了三位接受多脏器移植的患者的粘膜血流。在移植后的前4周内，通过回肠造口术进行了37次测量。大多数测量是在内镜检查和活检后24小时内进行的。术后第一周，粘液灌注增加，最终稳定在每例患者的特定水平。在移植胰腺炎期间，粘液灌注保持稳定，但在急性排斥反应和脓毒症期间，粘液灌注较基线（先前测量的平均值）下降35%至55%。在移植后第一周，粘膜灌注逐渐增加，这可能反映了再灌注损伤后的再生。粘膜灌注增加似乎与排斥反应或其他不良临床事件无关。与先前测量值相比，粘膜灌注突然减少30%或更多与脓毒症发作和/或排斥反应相关。
Background. Graft endothelium constitutes a prime target during acute rejection. Infiltration of T cells, monocytes, and enhanced endothelial-leukocyte interactions result in microvascular impairment and altered perfusion.Materials and methods. We measured mucosal blood flow using a laser Doppler flowmeter in three patients undergoing multivisceral transplantation. Thirty-seven measurements were performed through the ileostomy over the first 4 weeks posttransplantation. Most measurements were performed within a 24-hour interval from endoscopy and biopsy.Results. Mucosal perfusion increased throughout the first postoperative week and eventually stabilized around levels specific for each patient. Mucosal perfusion remained stable during graft pancreatitis, but decreased 35% to 55% from baseline (the average value of the previous measurements) during acute rejection and sepsis. During the first week posttransplantation there was a gradual increase in mucosal perfusion, which might reflect regeneration after reperfusion injury. Increased mucosal perfusion did not seem to correlate with rejection or other adverse clinical events. A sudden decrease in mucosal perfusion of 30% or more compared to the previous measurements was associated with septic episodes and/or rejection.