title: Recipient preconditioning and donor-specific bone marrow infusion in a pig model of total bowel transplantation.
abstract: BACKGROUND
  In an outbred pig model of total bowel transplantation, we previously showed that simultaneous donor-specific bone marrow infusion (DSBMI), rather than promoting engraftment, sensitizes recipients and causes rejection; it also aggravates the risk of generalized graft-versus-host disease (GVHD) and infection, and tends to reduce recipient and graft survival. Small and large animal models of bone marrow-induced transplant tolerance suggest that some form of recipient preconditioning (RPC) may facilitate engraftment of co-transplanted bone marrow cells and fully expose their tolerogenic potential.
  
  
  METHODS
  In a preclinical model, we prospectively studied the effect of RPC on simultaneous DSBMI and total (i.e., small and large) bowel transplantation. RPC consisted of whole body irradiation with 400 R (day 0); some recipients additionally received horse anti-pig antithymocyte globulin (days -2, -1, and 0). We studied six groups of outbred pigs, all of which underwent at least a total bowel transplant: group 1, nonimmunosuppressed control pigs (n=5); group 2, nonimmunosuppressed DSBMI pigs (n=13); group 3, tacrolimus pigs (n=7); group 4, DSBMI+tacrolimus pigs (n=15); group 5, RPC+nonimmunosuppressed DSBMI pigs (n=11); and group 6, RPC+DSBMI+tacrolimus pigs (n=14).
  
  
  RESULTS
  RPC did not prolong overall survival at 7, 14, 21, and 28 days after transplant. Survival rates were 100%, 100%, 86%, and 71% in group 3; 71%, 43%, 29%, and 29% in group 6; 55%, 9%, 0%, and 0% in group 5; and 60%, 0%, 0%, and 0% in Group 1. Moreover, RPC (groups 5 and 6) increased the incidence of death from rejection, GVHD, and infection when compared with group 3. Survival was significantly higher for RPC+DSBMI+tacrolimus pigs (group 6), compared with RPC+nonimmunosuppressed DSBMI pigs (group 5). Survival greater than 28 days was noted only in pigs that received tacrolimus after transplant: 71% in group 3 versus 29% in group 6. With both RPC and DSBMI (groups 5 and 6), rejection, GVHD, and infection were not mutually exclusive events. In groups 5 and 6, at autopsy, the incidence of rejection and GVHD was 17%; rejection and infection, 17%; and GVHD and infection, 45%. A combination of all three immunologic events was noted in 14%.
  
  
  CONCLUSIONS
  RPC, combined with DSBMI, and with or without posttransplant immunosuppression, does not prolong survival after total bowel transplantation. Rather, it increases the incidence of death from rejection, GVHD, infection, or a combination of these three immunologic events. According to this preclinical study, RPC and unmodified DSBMI do not improve patient and graft outcome after total bowel transplantation and need to be refined before being applied clinically.
authors.affiliation: Department of Surgery and Biotherapy Program, University of Minnesota, Minneapolis 55455, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Gruessner
authors.forename: F M
authors.initials: FM
authors.lastname: Uckun
authors.forename: J
authors.initials: J
authors.lastname: Pirenne
authors.forename: R E
authors.initials: RE
authors.lastname: Nakhleh
authors.forename: E
authors.initials: E
authors.lastname: Benedetti
authors.forename: I
authors.initials: I
authors.lastname: Bekersky
authors.forename: C
authors.initials: C
authors.lastname: Troppmann
authors.forename: A C
authors.initials: AC
authors.lastname: Gruessner
mesh_terms: D000818:Animals; D016026:Bone Marrow Transplantation; D002423:Cause of Death; D006084:Graft Rejection; D006086:Graft vs Host Disease / Q000401:mortality; D007422:Intestines / Q000637:transplantation*; D015996:Survival Rate; D013552:Swine; D019172:Transplantation Conditioning