Related Experiment Videos
Recipient growth and nutritional status following transplantation of segmental small-bowel allografts
Insights
Pediatric small bowel transplantation using adult segmental grafts supports recipient growth but may lead to long-term vitamin deficiencies and fat malabsorption. Further research is needed for optimal outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Gastroenterology
Background:
- Small bowel transplantation in children presents challenges regarding graft size and recipient growth.
- The feasibility of using segmental intestinal allografts from adult donors for pediatric recipients remains an area of investigation.
Purpose of the Study:
- To evaluate the long-term effects of segmental small bowel transplantation from adult donors on growth and nutritional status in young recipients.
Main Methods:
- Orthotopic small bowel transplantation was performed in young rats using entire small bowel, jejunal, or ileal allografts from adult donors.
- Immunosuppression was achieved with cyclosporine, leading to indefinite graft acceptance.
- Nutritional parameters, vitamin levels, fecal fat, and serum triglycerides were assessed at 6 and 12 months post-transplantation.
Main Results:
- All recipients exhibited normal growth and weight gain comparable to controls.
- Segmental grafts led to significant reductions in fat-soluble vitamins (A and E) and elevated fecal fat by 10-12 months.
- Serum triglyceride levels normalized in whole small bowel graft recipients but remained reduced in segmental graft recipients.
Conclusions:
- Segmental small bowel allografts from adult donors can support normal growth in young recipients.
- Long-term use of segmental grafts may result in nutritional deficiencies and impaired fat metabolism.
- Whole small bowel transplantation may offer better long-term metabolic outcomes compared to segmental grafts.
Abstract:
Concerning small-bowel transplantation in children, the question arises whether a segmental small-bowel graft from an adult donor would permit normal growth of the young recipient. Orthotopic small-bowel transplantation was performed in 4- to 6-week-old Lewis rats weighing 100-135 g. The entire small bowel of the recipient was replaced with an intestinal allograft consisting of the entire small bowel (N = 6), the jejunum (N = 6), or the ileum (N = 6) from adult Brown Norway rats. Immunosuppression with cyclosporine (15 mg/kg im) on alternate days for 4 weeks achieved graft acceptance of indefinite duration. Six and twelve months after transplantation, all recipients demonstrated normal global nutritional parameters (hematocrit, serum albumin) and gained weight at a rate comparable to that for age-matched controls. Nutritional deficiencies did not become apparent clinically. By 10 to 12 months, the levels of fat-soluble vitamins (A and E) were reduced significantly in recipients of segmental grafts. Vitamin B12 levels were also reduced but not significantly. Fecal fat was significantly elevated in all rats with grafts (3.2 +/- 1.0 to 4.8 +/- 0.9 g fat/100 g stool; controls, 1.8 +/- 0.4), but the increase was most pronounced in those with jejunal grafts (4.7 +/- 0.9). This was paralleled by a reduction in serum triglyceride levels in all transplanted rats, a reduction which reverted to normal by 10 to 12 months for rats with entire small-bowel grafts but not for those with segmental grafts. Graft biopsy demonstrated normal intestinal architecture with villus hyperplasia of segmental grafts.(ABSTRACT TRUNCATED AT 250 WORDS)