Graft survival rates after intestinal transplantation (ITx) are still the lowest in comparison to other solid organ transplants. One of main reasons is frequent occurrence acute cellular rejection (ACR). Vedolizumab an antibody against α4β7+ integrin involved gut-homing T cells which has been approved for inflammatory bowel diseases (IBD). We report its off-label use treat ACR ITx.Following abdominal wall (AWTx) and ITx, clinical course was followed biochemically. Sequential small biopsies...

Abstract Intestinal preservation for transplantation is accompanied by hypoperfusion with long periods of ischemia total blood cessation and absolute withdrawal oxygen leading to structural damage. The application intraluminal has been successfully tested in small-animal series during storage transport the organ but have so far clinically unrelatable. In this study, we whether a simple approachable method could prevent ischemic damage large animal model, warm time. We utilised local no-flow...

The most common cause of late graft loss in intestinal transplantation is chronic allograft enteropathy (CAE). diagnosis often delayed because symptoms and signs, the only available treatment enterectomy. We present first case CAE successfully treated with a gut-specific integrin blocker.

Introduction: The gold standard for intestinal allograft preservation is University of Wisconsin solution (UW). In animal models, Institute Georges Lopez (IGL-1) improved graft viability and epithelial repair compared to UW. It an extra-cellular with high sodium low potassium content in contrast UW presence polyethylene glycol, resulting lower viscosity. aim this study evaluate IGL-1, the first time, as a clinical transplantation (ITx). Methods: We performed retrospective analysis (January...

Introduction: Survival rates of small bowel (SB) grafts are the lowest among solid organ transplantations.[1] Unique for transplantation (SBx) is presence a large volume metabolically-active luminal content consisting complex mixture microbes, dietary and waste products. This may decrease mucosal integrity during preservation, which might lead to bacterial translocation predispose rejection graft. Cold storage SB limited maximum 10 h after it deemed unsuitable transplantation.[2] Luminal...

Background. Intestinal transplantation depends on donation after brain death (DBD). Luminal preservation (LP) has been beneficial against injury in previous studies animal models, but none include DBD. This study aims to investigate whether these benefits occur also with Methods. Wistar rats (male, N = 9) underwent for 2 h. Thereafter, vascular perfusion was done University of Wisconsin solution (UW). The small intestine then explanted and randomized into 3 groups: control (empty segment),...

Background: Intestinal transplantation (ITx) has shown sub-optimal graft survival rates for the last ten years, mostly due to rejection and subsequent sepsis. This could be improved by reducing initial preservation injury. Experimental studies applying luminal (LP) animal human intestines show promising results. Herewith presented is first trial of LP from suitable donors in a clinical setting. Methods: Twenty-five bowels (small intestine ascending colon) brain-dead meeting criteria ITx (age...

Background: Two patients with different disease backgrounds underwent intestinal transplantation (ITx) and afterwards had either acute cellular rejection (ACR, patient 1) or chronic allograft enteropathy (CAE, 2). Both received vedolizumab, which successfully managed their episodes have been free of complaints ever since. Vedolizumab is a monoclonal antibody that targets the integrin α4β7, expressed in inflammatory cells intestine, blocks interaction its endothelial cell receptor MAdCAM-1,...

<title>Abstract</title> <bold>Background</bold>. Intestinal preservation for transplantation is accompanied by hypoperfusion with long periods of ischemia total blood cessation and absolute withdrawal oxygen leading to structural damage. The application intraluminal has been successfully tested in small-animal series during storage transport the organ but have so far clinically unrelatable. In this study, we whether a simple approachable method could prevent ischemic damage large animal...

Metabolic syndrome is closely related to insulin resistance and dysglucemia able, by this mechanism, alter renal function. Consequently, kidney hyperfiltration the first finding in these individuals. Aims: We evaluated 182 subjects incidence of dysfunction its relation with different components metabolic syndrome. Methods: From studied, 41 % (mean age: 49y, 46–55) had (MS) according NCEP criteria 59% 45y, 39–53) were without (non-MS). Blood pressure was registered automatically triplicate a...

Introduction: The inhabitants of the intestine, especially microbiota, are recognized as an important factor in function gut. During intestinal transplant procedures, bowel, and therefore also is under influence extreme circumstances (e.g. cold storage), will change. Therefore, we studied microbial composition donor bowels during preservation. Method: With given consent family obtained five - that were not matched for transplantation from Donation by Brain Death donors, with full length...

Introduction: Standard intestinal graft preservation consists of vascular perfusion (VP) followed by static ice-cold preservation. This method was developed for liver and kidney transplantation, but does not consider the mucosa that is extremely sensitive to ischemia-reperfusion injury (IRI). Studies in animal models have shown luminal reduces mucosal damage. However, no experiments been performed yet reflecting organ donation procedure as it is, nor a reperfusion model show effects on IRI....

Introduction: Research on intestinal bowel transplantation is vivid and necessary, but the search for a good reperfusion (ex vivo) model remains. The use of precision-cut slices (PCIS) might be to study reperfusion. PCIS an ex vivo preserving multicellular structure intestine, permitting cells interact thus mimicking in situation.1 It postulated that butyric acid during could beneficial bowel.2 Method: For this study, we acquired (until now) bowels 4 Dutch Brain Death donors consented their...

Introduction: Intestinal transplantation is an accepted treatment option for patients with end-stage intestinal failure. Despite several improvements in immunosuppressive regimes that are largely adapted from other solid organ programs, rejection of the graft still far exceeds rates organs.[1] Vedolizumab antibody against gut homing α4β7 receptor, which prevents entry various immunological cell types into graft.[2] It approved use inflammatory bowel diseases and marketed because its...

Introduction: Outcome after intestinal transplantation (ITx) has improved, however acute cellular rejection (ACR) remains a frequent challenge restricting long-term results. The gold standard for diagnosis of ACR is histological analysis graft biopsies. diagnostic criteria were defined during the 2003 VIIIth International Small Bowel Transplant Symposium. Although this report provided consensus international reporting, it not been validated in clinical setting. aim our study was to evaluate...

Introduction: Chronic allograft enteropathy (CAE) is the main cause of intestinal graft loss two years post transplantation. Clinical course insidious and silent, medical treatment disappointing. While its physiopathology mostly unknown, golden standard for definitive diagnosis CAE histopathological analysis resected graft. In there atrophy mucosa with fibrosis remarkable vasculopathy middle-sized arteries. Vedolizumab, a humanised anti-α4β7 integrin antibody, currently in use inflammatory...

Introduction: Graft survival rates in intestinal transplantation (ITx) are the lowest among solid organ transplantation. Unique for ITx is presence of metabolically-active luminal content consisting microbes, dietary and waste products. Ischemic damage during cold storage decreases mucosal integrity, which contributes to graft rejection infections. Cold bowel limited 10 hours, after it deemed unsuitable Luminal preservation (LP) with polyethylene glycol (PEG) has shown promising effects...

In intestinal transplantation the 5-year graft survival rates are under 60%. Preservation and reperfusion injury is thought to play a role in immune activation rejection. Animal models thus needed better understand pathophysiology during procedure. The protective effects of additional luminal preservation (LP) with an ice-cold solution have been consistent previous animal studies, but none these include donation after brain death (DBD). We aimed test whether beneficial LP occur also DBD...