Beneficial effects of microsurgical lymphatic reconstruction after intestinal transplantation in rats

Lymphatic Vessels: The Next Frontier in Lung Transplant

Lymphatic vessels are essential for the uptake of fluid, immune cells, macromolecules, and lipids from the interstitial space. During lung transplant surgery, the pulmonary lymphatic vessel continuum is completely disrupted, and, as a result, lymphatic drainage function is severely compromised. After transplantation, the regeneration of an effective lymphatic drainage system plays a crucial role in maintaining interstitial fluid balance in the lung allograft. In the meantime, these newly formed lymphatic vessels are commonly held responsible for the development of immune responses leading to graft rejection, because they are potentially capable of transporting antigen-presenting cells loaded with allogeneic antigens to the draining lymph nodes. However, despite remarkable progress in the understanding of lymphatic biology, there is still a paucity of consistent evidence that demonstrates the exact impacts of lymphatic vessels on lung graft function. In this review, we examine the current literature related to roles of lymphatic vessels in the pathogenesis of lung transplant rejection.

Technical experiences with a microsurgical model of lymphatic reconstruction after intestinal transplantation in rats

The surgical procedure of intestinal transplantation disrupts the graft's lymphatic drainage. Despite morphological regeneration, the functional impairment of the lymphatic system may contribute to many pathophysiological changes after transplant. We describe the technical details and results of a microsurgical model of lymphatic reconstruction (LR), which immediately reconstitutes lymphatic drainage of the intestinal graft in rats. A total of 42 orthotopic intestinal transplants with LR was performed. The patency of the LR was assessed between postoperative days 2 and 100 using either methylene-blue staining of the lymphatic vessels or mesenteric lymphoradiography. A total patency rate of 88% was achieved. Genetic background, occurrence of rejection, and immunosuppressive treatment with cyclosporine did not affect the patency rate. Technical aspects and potential applications of this model are discussed.