7 49 Department of Gastroenterology and Hepatology, University Medical Center Groningen Gerard Dijkstra Intestine Transplant Association 985 0 887,09 555 79 5 0 EU 4 7 8 5 00 5 0 activity University Medical Center Groningen UMCG 00 7 5 75% 70% International registry active center 47 UMCG 008 UM/JMH,700 75 ECFMG 00 0 UM/JMH 50 00 0 0
440 Vol. 50, No. 4 5 00 60 5 ASTS ASTS UM/JMH 70% 00 05 40 5 5,0 47 00 0 fellowship fellowship program program program 50 0 0 50 5 4 clinical fellow duty work Dr. Grant thymoglobulin tacrolimus/ steroids tacrolimus Sick Kids Hospital intestinal rehabilitation program breakthrough homeostasis
7 44 90 Alexis Carrel 964 Deterling 967 Lillihei 988 985 8,887 5 0 78% 56% 4% QOL B QOL QOL - 4 5 4 5 5 Hirschsprung Hirschsprung 8 IMG
44 Vol. 50, No. 4 5 HGIND 4 MMIHS SD IASACIIP 4 HG CIIP MMIHS MMIHS 7 8,56 g 7 4 5 Pull through Soave 7 Crohn 6 50 cm.5 SD 9 kg.0 SD0 CV Crohn Megacystis microcoon intestinal hypoperistalsis syndrome MMIHS Hirschsprung PN HPN MMIHS 5 6 8 HPN 5 7 4 6 ω HPN MMIHS
7 44 Hirschsprung hypoganglionosis 0 TPN TPN MMIHS TPN TPN hypoganglionosis 6 7 9 8 5 TPN 4 CIIPS m 70 cm 6 TPN 4 58 ABO Treiz 55 cm CyA MMF PSL CyA Tac 44 57 0 cm CV 46 4 5 6 4 5 6 0 04 4 0 6 07 07 45. 0 49.96 cm 8 4.9%
444 Vol. 50, No. 4 5 ischemic reperfusion I/R in vivo real time LysM-eGFP 45 BX6WI FV000MPE Mai Tai HP Deep See femtosecond-pulsed laser TRITC-Albumin 0 5 40 60 4 0 6 4 in vivo I/R 4 4 control I/R Miz, 5 kg n 7 n 7 6 CCl HO- IL-b IL-6 TNFα inos IFNγ put in 6 HE Put in CCl IL-b IL-6 TNFα inos IFNγ 6 IL-b IL-6 put in 6 6
7 445 DA RT-a LEW RT-l 0 cm LEW RT-l LEW to LEW A DA to LEW B DA to LEW MAdCAM- C C B CD 4 T cell CD8 T cell B C IL- Mixed Lymphocyte Reaction MLR IL- Flow Cytometry B C T cell Background and Aim Tissue-engineered small intestine TESI has been reported. The aim of the study was generating TESI from cultured Lgr5 stem cells. Methods We used Lgr5-EGFP transgenic mice for small intestinal crypts isolation. After day 7-9, cultured crypts with Lgr5 epithelial stem cells were seeded onto biodegradable polymer scaffold and implanted with wrapping into omentum of adult NOD/SCID mice. Thereafter, recipient mice were sacrificed at 4 weeks after implantation for further immunohistological analysis. Results TESI was successfully generated from Lgr5 stem cells with differentiation into intestinal epithelium in vivo. Epithelial development was comparable to the native small intestine. Intestinal epithelium in TESI was immunohistochemically positive for Paneth cells, enteroendocrine cells, goblet cells, enterocytes and Ki67. Conclusion These observations suggest that transplanted Lgr5 stem cells can differentiate in vivo to the intestinal epithelium with further proliferative activity. Further investigation of this protocol may provide novel clinical applications in the field of transplantation including replacement or support of the intestinal function. biotube biosheet biotube biotube bio-alimentary-tube 4 biotube biotube 5 5 Hypoganglionosis 5,045 g Hypoganglionosis 9 50 cm TPN 7 4,80 g 70 cm Reversed Bishop-Koop
446 Vol. 50, No. 4 5 6 SD 5.5 SD 0 50 cm TPN 70 kcal/kg/ day EDP 0.7 kcal/ml MCT Reversed Bishop-Koop 4 5 GH ASPEN HPN JSPEN ASPEN HPN QOL HPN HPN HPN HPN QOL ω 4 4 IFALD ω omegaven 0 9 04 ω IFALD.0 mg/dl 9 omegaven 8,09 g 5,560 g 4.5 mg/dl omegaven 57 8 7 Omegaven 9 450,9,00 ω IFALD Omegaven
7 447 ω ELBWI PNALD ELBWI PNALD ω ELBWI 6 4 6 65.4 g 4.7 cm ω 06. 4 4 ω ELBWI PNALD 4 5 6 4 5 6 Hirschsprung 0 CV 6 CT 4 5 6 8 hypoganglionosis 0 50 cm autograft ratg
448 Vol. 50, No. 4 5 4 8 ACR ratg 47 ACR CMV viremia ratg 00 0 9 00 9 6 0 9 A IL- IL-Ra B IL-Ra C ATG A B 64 C 9 A 00% B % C 00% A % B % C 00% A A B 00% C % A 67% B 00% C % 5 A B C ATG C / 006 04 4 Hirschsprung / 47 40 48 BMI.6 0. 9.6BSA.7.5. BMI 0 6 0 0 40 cm 50 0 50 cm 5 7 56 5 55 49 8 9 5
7 449 CV CV CVC CV CT CVC 0 CRBSI CV CVC 9 CRBSI CVC CVC 4 CT CVC CRBSI 7 CRBSI CV CT CVC CV IFALD IFALD 8 9 00 cm Tacrolimus Steroid Daclizumab NH 4 7 F 4 Tacrolomus Everolimus Prednisolone IFALD
450 Vol. 50, No. 4 5 4 5 0cm 0 4 AST 78 ALT 44 TBil.8 6 8 75 AST 70 ALT 80 TBil 6.078 9 Hirschsprung OKT- CMV 5 48 6,850 ml CMV 5 0 0 / PRA graft survival HLA