Small bowel transplantation in the rat with immediate restoration of intestinal continuity

Compared with other rat transplant models, small bowel transplantation (SBT) is associated with higher peritransplant morbidity and mortality. We describe a two-stage technique of SBT in the rat that minimizes perioperative complications and also allows immediate restoration of intestinal continuity. Inbred Lewis strain rats were used as donors and recipients. A one-stage technique was originally adopted whereby the distal 50% of the jejunoileum was transplanted followed by near-total resection of the native small intestine and restoration of intestinal continuity. Among 20 rats transplanted with this technique, only one survived longer than 30 days. With the two-stage technique, transplantation of the donor jejunoileum in continuity was performed, followed by native enterectomy 7 days later. With the two-stage technique 17 of 20 rats survived indefinitely (greater than 50 days). Other important technical modifications are described. In the hands of a skilled microvascular surgeon, the two-stage SBT technique results in consistently improved survival and minimal morbidity.