Reconstruction of the intestinal lymphatic drainage after small bowel transplantation

Background. The surgical procedure of small bowel transplantation normally results in complete disruption of the graft's lymphatic drainage. The prese nt study was undertaken to determine the impact of lymphatic reconstruction (LR) on the outcome of intestinal grafting, using a microsurgical model th at immediately restores lymphatic drainage. Materials, Brown Norway (RT1(n)) intestinal grafts were orthotopically tran splanted into Lewis (RT1(1)) rats either with LR (+LR) or without LR (-LR), Recipients were randomly allocated into the following groups: no treatment or cyclosporine (CsA) at a dose of 2, 5, or 10 mg/kg/day subcutaneously fr om postoperative day (POD) 0 to 6, Results. There was morphological regeneration of lymphatics in the -LR grou p between 1-3 weeks as previously reported, whereas normal lymph flow was i mmediately restored in the CLR group. All untreated and CsA(2 mg)-treated a llografts were rapidly rejected in both the +LR and -LR groups, In the grou ps treated with similar to similar to 5 mg of CsA, five of six -LR animals died of chronic rejection between 38 and 86 days (mean survival time+/-tSD: 76.7+/-21 days), while all +LR animals survived unit similar to 1 death on POD 100 (P < 0.05), Histological features of mucosal damage found in -LR g rafts were absent in the +LR grafts, AU of the animals treated with 10 mg: of CsA survived indefinitely. Sequential histology revealed mild rejection in -LR and +LR grafts on POD 45, but +LR animals had significantly higher b ody weight gains (POD 50: -LR: 117+/-12% vs. +LR: 136+/-4%, P < 0.01). LR d id not affect donor cell. migration and nutritional parameters, Conclusion, Ln improves the long-term results of small bowel transplantatio n resulting in better survival rates, less mucosal damage due to chronic gr aft rejection, and greater weight gain. We conclude that impairment of lymp h flow may contribute to poor outcomes when standard surgical techniques ar e used for small bowel transplantation.