Surgical treatment itself induces bacterial translocation.

Abstract

Although effective immunosuppressive drugs have recently been introduced into clinical organ transplantation, the prognosis for small bowel transplantation (SBT) is still poor compared with the other organ transplantation techniques. The high incidence of severe infections and sepsis that has emerged after SBT is as remarkable as graft rejection(1). We read with interest the report by Gianotti et al.(2). They studied the timing, degree, and distribution of bacterial translocation (BT) in the rat using the heterotopic auxiliary SBT model. Graft function was evaluated by urinary excretion of lactulose and mannitol injection. The intestinal permeability was also evaluated by injection of labeled Escherichia coli into the graft, and BT was quantitated by radionuclide counts and scintigraphic imaging. The results showed that the lactulose to mannitol ratio significantly increased until day 3 and returned to normal values on day 5 after SBT and that BT was strikingly enhanced on day 1 but returned to the pretransplant value on day 3. Because BT has been shown to be induced by hemorrhagic shock(3), we focused on the effect of surgical treatments on BT (4). It was confirmed that BT was induced by laparotomy alone; twenty-four hours after laparotomy, the rats were killed and the their mesenteric lymph nodes were cultured. All materials (four samples) showed positive colonies, which were 0.1-1.8×103 colonies/gE coli and 2.6×103 colonies/g E faecolis. However, peritoneal insufflation with carbon dioxide did not induce BT(4). Based on these findings, we think that exposure of the peritoneal cavity to air induced BT. Gianotti et al. (2) also reported that the timing and degree of BT did not correlate well with morphologic and permeability changes of the graft, and that alterations of graft morphology were not always associated with increased BT and subsequent septic episodes. We studied the changes in lipid absorption of the allointestinal grafts after immunosuppressants were stopped (5). Before the rejection was demonstrated histologically, fat excretions in the feces were markedly increased. The relation between the timing and degree of BT and graft function should be studied further. Eiji Kobayashi1 Akio Fujimura Departmental of Clinical Pharmacology; Jichi Medical School; Tochigi 329-04, Japan