Interruption of the Lymphatic Vessels and its Consequences in Total Homotransplantation of the Small Intestine-and Ri_ght Side of the Colon in Man

Abstract

The problems of total lymphatic drainage interruption have been studied in a case of total
homotransplantation of the small bowel and right colon with a clinical survival of 26 days.
Marked stasis with distension of lymphatic tracts was noticed both in the mucosa of the
colostomy and in the mesentery. At postmortem examination, no lymphatic regeneration was
observed 26 days after grafting. Histological slides of the mesentery showed areas of oedema
associated with pronounced lymphangiectasis. The lymphatic cavities were filled with red cells
and the lymph nodes were apoplectic. The absence of lymphatic regeneration is a point of real
interest, especially concerning both the secondary sclerosis owing to the lymphedema, that would
compromise the function of the graft, and the absorption of fatty acids.
The absorption of these acids by the venous route either directly or indirectly through
spontaneous lympho-venous anastomosis, in fact, seems to be a sufficient by-pass. Under these
conditions, ligature of the lymphatics of the transplant is a safe procedure, thus preventing
retro-peritoneal lymphorrhagia or chylous ascites. However, it would be perhaps useful to
create such a lympho-venous anastomosis in order to diminish the stasis in the transplant until
regeneration of lymphatics occurs.
The abundance of lymphatic tissue at the level of the intestine and the important
role it plays in collecting and carrying away fat absorbed from the digestive mucosa
suggested that interruption of the lymphatic vessels during intestinal transplantation
might raise a number of special problems.
In the light of experimental results and our own findings following intestinal
homotransplantation in man we shall attempt to bring our knowledge up to date in
regard to the following five essential points:
- the immediate repercussions of raised lymphatic pressure on the graft;
- the late consequences of prolonged lymphatic stasis on the graft;
the consequences of lymphatic interruption on absorption of fat;
the possibilities of lymphatic regeneration in man;
- the possible immunological consequences of lymphatic stasis on the intestinal graft.