腹壁和小肠同步移植:四年随访的重要启示

Nicholas C. Oleck, Ralph Erdmann, K. Ravindra, Debra Sudan, Brett T. Phillips, S. Mithani, Detlev Erdmann, Andrew Atia
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引用次数: 0

摘要

这篇对同步腹壁异位移植(AW-VCA)和小肠移植的四年随访揭示了腹壁VCA的新见解和创新。该病例涉及一名 37 岁的男性退伍军人,展示了腹壁同种异体移植(AW-VCA)在解决肠移植(ITx)中腹腔域缺失问题方面的优势。四年后,导致AW-VCA和小肠移植物最终发生排斥反应的事件凸显了移植物存活率、患者依从性和免疫抑制管理之间复杂的相互作用。值得注意的是,AW-VCA 和 ITx 排斥模式之间存在明显的不一致,这对将 AW-VCA 中的皮肤成分作为 ITx 排斥的早期指标的可靠性提出了质疑。此外,在切除小肠移植物后观察到的腹部血管化筋膜的行为,让人们对仅筋膜移植物的免疫反应有了新的认识。此次随访强调了移植物存活、患者依从性和免疫抑制管理的复杂性,突出了该领域持续研究和创新的必要性。
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Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at Four Year Follow Up
This four-year follow-up of synchronous abdominal wall allotransplantation (AW-VCA) and small bowel transplantation reveals novel insights and innovations in abdominal wall VCA. The case, involving a 37-year-old male Army veteran, showcases the benefits of AW-VCA in addressing loss of abdominal domain in intestinal transplantation (ITx). The events leading to ultimate rejection of both the AW-VCA and small bowel graft at four years highlights the complex interplay between graft survival, patient compliance, and immunosuppressive management. Notably, a significant discordance between AW-VCA and ITx rejection patterns was identified, questioning the reliability of skin components in AW-VCA as early indicators of ITx rejection. Furthermore, the behavior of the vascularized abdominal fascia, observed post-excision of the small bowel graft, offers new understanding of the immunologic response to fascia-only grafts. This follow-up emphasizes the complexities of graft survival, patient compliance, and immunosuppressive management, underscoring the need for ongoing research and innovation in the field.
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