Naoshi Mitsuoka

Graft-versus-Host Reaction in Small-Bowel Transplantation and Possibilities for Its Circumvention

To study graft-versus-host reaction (GVHR) in small-bowel transplantation and its underlying mechanisms and to find methods for circumventing GVHR, we used an unidirectional GVHR model in which F1 Lewis (LEW) × Wistar King A (WKA) hybrid rats received small-bowel transplants from either LEW or WKA parent rats. The survival time of F1 hybrid rats that received full-length small-bowel transplantation from LEW and WKA was 16.3 ± 2.1 days and 18.2 ± 3.4 days, respectively. When one-quarter of LEW small bowel was transplanted to an F1 hybrid recipient, the survival time was significantly longer at 44.0 ± 23.4 days compared with rats that had received full-length LEW small-bowel transplantation. The survival time of F1 hybrid rats which received an injection of high-dose (5 × 108 cells) LEW or WKA spleen cells was 11.9 ± 4.0 days and 13.1 ± 3.6 days, respectively. However, when an injection containing a low dose (1 × 108 cells) of LEW spleen cells was used, survival was > 100 days, showing significance compared with the survival of rats receiving the higher dose LEW spleen-cell injection. Both small-bowel transplantation and spleen-cell injection were compared for the effective period of recipient resistance to donor cell or small-bowel transplantation as second challenge. When the F1 rats given a quarter LEW small-bowel transplant as first challenge were treated with a high-dose of spleen cells 30 days after transplantation, they survived for > 30 days without GVHR. F1 rats that were treated with a low-dose LEW spleen-cell injection, followed 30 days later by full LEW small-bowel transplantation, had a survival time of > 100 days. These results indicate that segmental small-bowel transplantation and spleen-cell injection as first challenge may facilitate the prevention of GVHR, resulting in resistance to subsequent immunological challenge

Erratum to: Clinical experience with four cases of jackhammer esophagus

progression from nutcracker esophagus [NE; the Chicago Classification (2012 version)] to JE was observed during the course of 2 of the 4 patients. In 1 of the 4 patients, the symptoms improved in the absence of treatment. Among the 3 patients who received treatment, the symptoms of 2 patients were controlled within tolerable intensity by conservative treatment, but surgical treatment was selected in the other case. However, because the symptoms recurred after the operation, peroral endoscopic myotomy was performed in addition. Conclusions Because the pathology at the onset and clinical course of JE are not uniform, it is necessary to tailor treatment policy to each individual case and to consider altering treatment policy according to the patient’s clinical course.