Untersuchungen zur Regeneration des Lymphabflusses nach D�nndarmtransplantation

Abstract

Since the resorption of long-chained fatty acids proceeds exclusively via the lymphatics, the regeneration of lymphatic flow from small bowel grafts takes on a significant role. An isogene, heterotopic small bowel transplant was performed in a total of 54 Lewis rats, whereby 27 animals received no immunosuppression (group A) and the remaining 27 rats received cyclosporin A (group B). The lymphatic regeneration was determined by instilling dye into the mesenterial lymph nodes of the graft between day 1 and day 42 after transplantation and measuring the interval between instillation and appearance in the retroperitoneal lymph channels of the host. Additionally, the severity of the lymph edema was examined in histological slides, and the lymph vessels of the villi were examined for the presence of chylomicrons. In group A the passage of the dye into the lymphatic system first occurred on day 3 after transplantation, namely after a mean of 11.8 min, while in group B the lymph channels of the retroperitoneum first became visible on day 7 after transplantation (mean 8 min after instillation). Passage of the dye out of the lymphatic system of the graft was prompt and unhindered from day 10 in group A and from day 14 after transplantation in group B. In all grafts there was a marked interstitial lymph edema during the first week, and it was less severe in both groups up to day 14. Chylomicrons in the villi were observed in group A as of day 10 and after two weeks in group B. Regeneration of the lymphatics in small bowel grafts thus appears to be adequate for enteral nutrition only after 14 days.