Lymphatic Reconstruction after Intestinal Transplantation in Rats

Abstract

Intestinal transplantation (IT) restores the vascular circulation and the luminal flow of the graft, although many other aspects of its morphological and functional integrity remain compromised after transplantation [1]. An important anatomical structure which is essential for normal gut function and initially disrupted by the transplant is the intestinal lymphatic drainage. As part of a complex network of vascular and lymphatic circulation, the intestinal lymphatic system collects lymph fluid from the small intestine, then drains it through the thoracic duct into the systemic circulation [2, 3]. Its function involves transporting absorbed lipids, providing a conduit for the migration of lymphocytes, and regulating interstitial fluid exchange [4]. Morphological regeneration of the lymphatic drainage becomes evident by 4 weeks after IT through small collaterals (Fig.4d) [5–7]. However, to what extent the disrupted lymphatic drainage impairs graft function and immunology and how the collaterals mimic a physiological lymphatic drainage is poorly understood. A novel microsurgical model that reconstitutes lymphatic drainage immediately after IT was developed by Szymula von Richter and his colleagues in 1996 [8]. Recently, we modified this model, achieving a success rate of 87%. We describe here the details of this microsurgical model, the assessment of the patency of lymphatic anastomosis, and potential applications.