Small Bowel Transplantation and Bacterial Translocation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Shicheng ¹ , SHI De. ²

Department of General Surgery, The First People’s Hospital of Yunnan Province，Kunming 650032;

Corresponding author：

Keywords：

Small bowel transplantation; Bacterial translocation; Gut barrier function

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Objective To discuss the cause and prevention of bacterial translocation after small bowel transplantation (SBT). MethodsMost of the existing literatures concerning bacterial translocation and SBT were reviewed. ResultsThe ischemia/reperfusion injury, graft rejection, graft versus host disease (GVHD) and administration of immunosuppressive drugs were associated with the gut barrier damage, intestinal mobility and transmit dysfunction and luminal potentially pathogenic bacterial overgrowth after SBT which caused the germs and toxin to translocate into recipient tissues, and posed a major threat on the development of sepsis. Conclusion The rate of bacterial translocation after SBT is higher than that of other types of solid organ transplantation,which is the main cause of recipient sepsis affecting the outcome of SBT. Improving the surgical techniques, shortening ischemia preservation time, selective bowel decontamination and improving the methods of nutritional support and immunosuppression would decrease the incidence of bacterial translocation and sepsis, and improve the outcome of SBT.

Citation： LUO Shicheng,SHI De.. Small Bowel Transplantation and Bacterial Translocation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2002, 9(4): 288-290. doi: Copy

1.	Bueno J, Ohwada S, Kocoshis S, et al. Factors impacting the survival of children with intestinal failure referred for intestinal transplantation [J]. J Pediatr Surg, 1999； 34(1)∶27.
2.	Grant D. Intestinal transplantation: 1997 report of the international registry. Intestinal Transplant Registry [J]. Transplantation, 1999； 67(7)∶1061.
3.	Asfar S, Atkison P, Ghent C, et al. Small bowel transplantationA lifesaving option for selected patients with intestinal failure [J]. Dig Dis Sci, 1996； 41(5)∶875.
4.	Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome [J]. Eur J Surg, 1996； 162(4)∶259.
5.	van der Waaij D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: colonizationcontrolling mechanisms and consequences for antibiotic treatment [J]. Infection, 1983； 11(Suppl 2)∶S90.
6.	Adams DH, Shaw S. Leucocyteendothelial interactions and regulation of leucocyte migration [J]. Lancet, 1994； 343(8901)∶831.
7.	Beuk RJ, Heineman E, Tangelder GJ, et al. Total warm ischemia and reperfusion impairs flow in all rat gut layers but increases leukocytevessel wall interactions in submucosa only [J]. Ann Surg, 2000； 231(1)∶96.
8.	Massberg S, Gonzalez AP, Leiderer R, et al. In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation [J]. Br J Surg, 1998； 85(1)∶127.
9.	Gianotti L, Bergamo C, Braga M, et al. In vivo evaluation of timing, degree, and distribution of bacterial translocation following experimental small bowel transplantation [J]. Transplantation, 1995； 60(9)∶891.
10.	Ogita K, Hopkinson K, Nakao M, et al. Stress responses in graft and native intestine after rat heterotopic small bowel transplantation [J]. Transplantation, 2000； 69(11)∶2273.
11.	Lee TK, Heeckt P, Smith SD, et al. Postoperative selective bowel decontamination prevents gramnegative bacterial translocation in smallbowel graft recipients [J]. J Surg Res, 1995； 58(5)∶496.
12.	Nakada K, Ikoma A, Suzuki T, et al. Longterm effect of jejunoileal autotransplantation on motility and transit time in canine small bowel [J]. Transplant Proc, 1994； 26(3)∶1635.
13.	Sigurdsson L, Reyes J, Kocoshis SA, et al. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease [J]. Transplantation, 2000； 70(2)∶302.
14.	Price BA, Cumberland NS, Clark CL, et al. The effect of rejection and graftversushost disease on small intestinal microflora and bacterial translocation after rat small bowel transplantation [J]. Transplantation, 1993； 56(5)∶1072.
15.	Oishi M, Tanaka N, Orita K. Successful swine small bowel transplantation using FK506: effect on endotoxin translocation [J]. Transplant Proc, 1994； 26(4)∶2302.
16.	Fryer J, Grant D, Jiang J, et al. Influence of macrophage depletion on bacterial translocation and rejection in small bowel transplantation [J]. Transplantation, 1996； 62(5)∶553.
17.	Kellersman R, Zhong R, Kiyochi H, et al. Reconstruction of the intestinal lymphatic drainage after small bowel transplantation [J]. Transplantation, 2000； 69(1)∶10.
18.	Li YS, Li JS, Jiang JW, et al. Glycylglutamineenriched longterm total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig [J]. J Surg Res, 1999； 82(1)∶106.
19.	Zhang W, Frankel WL, Bain A, et al. Glutamine reduces bacterial translocation after small bowel transplantation in cyclosporinetreated rats [J]. J Surg Res, 1995； 58(2)∶159.
20.	de Oca J, Bettonica C, Cuadrado S, et al. Effect of oral supplementation of ornithinealpha ketoglutarate on the intestinal barrier after orthotopic small bowel transplantation [J]. Transplantation, 1997； 63(5)∶636.
21.	Biffi R, Privitera G, Pozzi S, et al. Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation [J]. Eur J Surg, 1997； 163(9)∶703.
22.	Zhang W, Frankel WL, Adamson WT, et al. Insulinlike growth factorⅠ improves mucosal structure and function in transplanted rat small intestine [J]. Transplantation, 1995； 59(5)∶755.
23.	Biffi R, Privitera G, Andreoni B, et al. Luminal bacterial overgrowth and intestinal translocation in pigs given either cyclosporin A or 15deoxyspergualin after small bowel transplantation [J]. Eur J Surg, 1995； 161(2)∶93.
24.	Langrehr JM, Machens C, Zill E, et al. Bacterial translocation during graftversushost disease after small bowel transplantation is reduced following inhibition of inducible nitric oxide synthesis [J]. Transplantation, 2000； 69(11)∶2415.

1. Bueno J, Ohwada S, Kocoshis S, et al. Factors impacting the survival of children with intestinal failure referred for intestinal transplantation [J]. J Pediatr Surg, 1999； 34(1)∶27.
2. Grant D. Intestinal transplantation: 1997 report of the international registry. Intestinal Transplant Registry [J]. Transplantation, 1999； 67(7)∶1061.
3. Asfar S, Atkison P, Ghent C, et al. Small bowel transplantationA lifesaving option for selected patients with intestinal failure [J]. Dig Dis Sci, 1996； 41(5)∶875.
4. Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome [J]. Eur J Surg, 1996； 162(4)∶259.
5. van der Waaij D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: colonizationcontrolling mechanisms and consequences for antibiotic treatment [J]. Infection, 1983； 11(Suppl 2)∶S90.
6. Adams DH, Shaw S. Leucocyteendothelial interactions and regulation of leucocyte migration [J]. Lancet, 1994； 343(8901)∶831.
7. Beuk RJ, Heineman E, Tangelder GJ, et al. Total warm ischemia and reperfusion impairs flow in all rat gut layers but increases leukocytevessel wall interactions in submucosa only [J]. Ann Surg, 2000； 231(1)∶96.
8. Massberg S, Gonzalez AP, Leiderer R, et al. In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation [J]. Br J Surg, 1998； 85(1)∶127.
9. Gianotti L, Bergamo C, Braga M, et al. In vivo evaluation of timing, degree, and distribution of bacterial translocation following experimental small bowel transplantation [J]. Transplantation, 1995； 60(9)∶891.
10. Ogita K, Hopkinson K, Nakao M, et al. Stress responses in graft and native intestine after rat heterotopic small bowel transplantation [J]. Transplantation, 2000； 69(11)∶2273.
11. Lee TK, Heeckt P, Smith SD, et al. Postoperative selective bowel decontamination prevents gramnegative bacterial translocation in smallbowel graft recipients [J]. J Surg Res, 1995； 58(5)∶496.
12. Nakada K, Ikoma A, Suzuki T, et al. Longterm effect of jejunoileal autotransplantation on motility and transit time in canine small bowel [J]. Transplant Proc, 1994； 26(3)∶1635.
13. Sigurdsson L, Reyes J, Kocoshis SA, et al. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease [J]. Transplantation, 2000； 70(2)∶302.
14. Price BA, Cumberland NS, Clark CL, et al. The effect of rejection and graftversushost disease on small intestinal microflora and bacterial translocation after rat small bowel transplantation [J]. Transplantation, 1993； 56(5)∶1072.
15. Oishi M, Tanaka N, Orita K. Successful swine small bowel transplantation using FK506: effect on endotoxin translocation [J]. Transplant Proc, 1994； 26(4)∶2302.
16. Fryer J, Grant D, Jiang J, et al. Influence of macrophage depletion on bacterial translocation and rejection in small bowel transplantation [J]. Transplantation, 1996； 62(5)∶553.
17. Kellersman R, Zhong R, Kiyochi H, et al. Reconstruction of the intestinal lymphatic drainage after small bowel transplantation [J]. Transplantation, 2000； 69(1)∶10.
18. Li YS, Li JS, Jiang JW, et al. Glycylglutamineenriched longterm total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig [J]. J Surg Res, 1999； 82(1)∶106.
19. Zhang W, Frankel WL, Bain A, et al. Glutamine reduces bacterial translocation after small bowel transplantation in cyclosporinetreated rats [J]. J Surg Res, 1995； 58(2)∶159.
20. de Oca J, Bettonica C, Cuadrado S, et al. Effect of oral supplementation of ornithinealpha ketoglutarate on the intestinal barrier after orthotopic small bowel transplantation [J]. Transplantation, 1997； 63(5)∶636.
21. Biffi R, Privitera G, Pozzi S, et al. Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation [J]. Eur J Surg, 1997； 163(9)∶703.
22. Zhang W, Frankel WL, Adamson WT, et al. Insulinlike growth factorⅠ improves mucosal structure and function in transplanted rat small intestine [J]. Transplantation, 1995； 59(5)∶755.
23. Biffi R, Privitera G, Andreoni B, et al. Luminal bacterial overgrowth and intestinal translocation in pigs given either cyclosporin A or 15deoxyspergualin after small bowel transplantation [J]. Eur J Surg, 1995； 161(2)∶93.
24. Langrehr JM, Machens C, Zill E, et al. Bacterial translocation during graftversushost disease after small bowel transplantation is reduced following inhibition of inducible nitric oxide synthesis [J]. Transplantation, 2000； 69(11)∶2415.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Small Bowel Transplantation and Bacterial Translocation

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