Most patients with recurrent intestinal metaplasia with or without dysplasia after ablation achieve a complete response. Recurrent disease commonly involves the area just below the NSCJ. Surveillance endoscopies should include this area to accurately identify patients with disease recurrence.
Purpose: Currently organ transplant patients require life-long treatment with powerful immunosuppressive drugs to prevent rejection. An alternative is to use either the donor thymus or bone marrow to promote acceptance without requirement for immunosuppression and such approaches have been partially successful. The aim is to combine both donor thymus and vascularised bone marrow transplantation to promote heart transplant acceptance in a rat model where the heart alone is rejected. Methods: Combined transplantation of the heart, thymus and sternum bone on the common vascular pedicle was performed between completely MHC matched transplants (Lewis strain donor to Lewis recipient) (n = 5) and completely mismatched (PVG to DA) (n = 3) rats. Transplant survival was checked by manual palpation of the transplanted heart to monitor heart beat. Results: All animals survived 120 postoperative days. Heart transplant survive time in syngeneic rats (Lewis to Lewis) was 120 days in all cases. However, in the completely mismatched (PVG to DA) transplants there was no significant difference between the simultaneous transplantation of the heart, thymus and bone marrow (survival times of 6, 7, 10 days), compared with survival of the transplanted heart alone (survival times of 8, 8,9,9,10,11 days).
Conclusion:The new method of the vascularised heart, thymus and sternum transplantation is surgically successful as demonstrated by the prolonged survival of syngeneic hearts, although this treatment alone did not prolong survival of mismatched hearts. The method provides a model for the manipulation of donor and recipient T cells which could provide a novel approach to inducing transplant acceptance.
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