INVESTIGADORES
RUMBO Martin
congresos y reuniones científicas
Título:
Analysis of Draining Leukocytes from the Abdominal Fluid to Monitor Immune Events after Intestinal Transplant. Follow up report
Autor/es:
DOMINIK MEIER; AGUSTINA ZAMBERNARDI; CAROLINA RUMBO; PAPPA GOBBI RODRIGO; FERRETINO MARIA; PEREZ FERNANDEZ IGNACIO; FERNANDO CHIRDO; GUILLERMO DOCENA; GABRIEL GONDOLES; MARTIN RUMBO
Reunión:
Congreso; XII International Small Bowel Transplantation Symposium; 2011
Resumen:
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Introduction: During intestinal transplant
(ITx) operation, intestinal lymphatics are not reconstituted. In our first
report, we described the factibility to identify cellular population and donor or
recipient origin in the abdominal draining fluid post-ITx. The aim of the
present study was to correlate variations of draining cells with post
transplant clinical events. Methods: Fourteen consecutive ITx
patients were included in the study (11 pediatric, 3 adult; 10 isolated, 2 liver/intestine,
2 multivisceral). Cell composition of the abdominal draining fluid was analyzed
periodically during the first 15 post-ITx days by flow cytometry. To exclude
blood contamination, only samples having less than 10,000 erythrocytes/ uL were
processed. The correlation between cell parameters (FSC-SSC pattern, CD4/ CD8
ratio, CD69 expression on T cells, increased number of NK/ NKT cells) and
clinical events was analyzed. Patients were divided into four study groups
according with the presence of post transplant complications as follow: Group
1: No-complications (n=3); Group 2: Diarrhea or increased ostomy output (n=4);
Group 3: Extra intestinal infections (n=4); Group 4: Others (pancreatitis, intrabdominal
hematoma) (n=3). Results: Group 1: Cellular pattern varied along
the post-ITx period from a mixed leukocyte pattern to an exclusively
lymphocytic pattern with predominance of CD4+ T cells (30-60%) by day 5
onwards. Different clinical events showed consistent patterns of cellularity. Group
2: Although the shift to a lymphocytic pattern was observed, a clear appearance
of granulocytes and monocytes was detected at the time of the clinical
complication. Group 3: Postoperative bacterial infections (3/4) had an increase
in the draining granulocytes concomitantly or before the diagnosis of the clinical
event. In the setting of viral infections (1/4) draining cells had a dominant increase
in monocytes over granulocytes. Group 4: This group presented similar changes
than group 2. In most cases with inflammatory adverse events concomitant
increase in proportion of CD69+ T cells, decrease of CD4/CD8 ratio and increase
of NK/ NKT cells was observed. Conclusions: Our results indicate that
cell analysis of the draining fluid from ITx recipients might be useful as a
tool to predict or to support clinical management. This follow up study support
the utility of this method to gain insight into intestinal transplant
immunobiology.