| Co-Investigator(Kenkyū-buntansha) |
UEMOTO Shinji Mie University, The first Dept of Surgery, Professor, 医学部, 教授 (40252449)
INOMATA Yukihiro Kumamoto University, Dept of Pediatric Surgery, Professor, 医学部, 教授 (50193628)
TANAKA Koichi Kyoto University, Dept. of Transplantation and Immunology, Professor, 医学研究科, 教授 (20115877)
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| Budget Amount *help |
¥12,500,000 (Direct Cost: ¥12,500,000)
Fiscal Year 2001: ¥3,100,000 (Direct Cost: ¥3,100,000)
Fiscal Year 2000: ¥9,400,000 (Direct Cost: ¥9,400,000)
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| Research Abstract |
Zoom-video endoscopy examination and immunohistochemical pathological examination were used for the diagnosis of rejection in orthotopic small bowel transplantation using porcines. Severe rejection in the group without immunosuppression was diagnosed easily by ordinary endoscopy and histology. Severe rejection was manifested as ulcer formation and loss of mucosa macrospocically, and large lymphocytes infiltration and marked apoptosis on crypt cells microscopically. On the other hand, rejection in the group with tacrolimus was mild, which could not diagnosed by conventional endoscopy, but by zoom-video endoscopy with the finding of short villious height. Moreover, enhancement of apoptosis inducing enzyme (caspase) and decrease of proliferation marker (Ki67) expression on epithelial cells, and enhancement of FasL, CD4, CD8, CD56, CD20, CD25 expression on lymphocytes were observed at the very early stage of rejection. In clinical setting, 2 cases of living donor small bowel transplantatio
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n and one case of cadaveric one were performed. Induction therapy with anti-IL2 receptor antibody was added to ordinary mmunosuppression regimen. Rejection was Blionitored by zoom-video endoscopy and immunohistochemical examination. All cases encountered only mild rejection, which was diagnosed by zoom-video endoscopy with the finding of short villious height, and by histology with the finding of apoptosis on crypt cells. Those mild rejection was treated successfully by steroids pulse therapy. Moreover, positive immunohistochemical findings were demonstrated at the very early stage of rejection, which did not need further treatment, but needed careful follow-up.
In conclusion, induction therapy with anti-IL2 receptor antibody was quite effective to decrease the risk of rejection in small bowel transplantation. In addition, monitoring of rejection by zoom-video endoscopy and immunohistochemical examination was useful for detecting the very early stage of rejection. Those new strategy could contribute to the establishment of small bowel transplantation. Less
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