Monitoring of the intestinal mucosal perfusion using laser Doppler flowmetry after multivisceral transplantation.
BACKGROUND
Graft endothelium constitutes a prime target during acute rejection. Infiltration of T cells, monocytes, and enhanced endothelial-leukocyte interactions result in microvascular impairment and altered perfusion.


METHODS
We measured mucosal blood flow using a laser Doppler flowmeter in three patients undergoing multivisceral transplantation. Thirty-seven measurements were performed through the ileostomy over the first 4 weeks posttransplantation. Most measurements were performed within a 24-hour interval from endoscopy and biopsy.


RESULTS
Mucosal perfusion increased throughout the first postoperative week and eventually stabilized around levels specific for each patient. Mucosal perfusion remained stable during graft pancreatitis, but decreased 35% to 55% from baseline (the average value of the previous measurements) during acute rejection and sepsis. During the first week posttransplantation there was a gradual increase in mucosal perfusion, which might reflect regeneration after reperfusion injury. Increased mucosal perfusion did not seem to correlate with rejection or other adverse clinical events. A sudden decrease in mucosal perfusion of 30% or more compared to the previous measurements was associated with septic episodes and/or rejection.
Oltean
M
M
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, 41345 Göteborg, Sweden. mihai@wlab.gu.se
Aneman
A
A
Dindelegan
G
G
Mölne
J
J
Olausson
M
M
Herlenius
G
G
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007081:Ileostomy; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000000981:diagnostic imaging*; D007422:Intestines / Q000637:transplantation*; D017078:Laser-Doppler Flowmetry / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011184:Postoperative Period; D012039:Regional Blood Flow; D014463:Ultrasonography