Small bowel transplantation in rats: endoscopic and histological evaluation of graft rejection

Heterotopic small bowel transplantation was performed using the cuff technique in DA(RT1a) to PVG(RT1c) rat fully allogeneic combination. In this model, the rejection course of the grafted intestine was evaluated endoscopically via double stomata and was classified into four stages. Early changes appeared on postoperative day 3. Stage I: The mucosa of the grafted intestine showed patchy paleness and loss of the capillary fine network patterns, accompanied by microerosions. Closer examination revealed irregularity of the epithelial height and arrangement. Stage II: The damage spread progressively over the entire mucosa on day 4-5. Stage III: On day 6-7, the necrotic epithelium became detached, showing multiple ulcers which provoked hemorrhagic enteritis. Stage IV: Graft rejection was completed with total necrosis and white scar tissue formation by day 10-14. These endoscopic findings of the mucosa of the grafted intestine corresponded closely to the time course of pathological examinations. We conclude that endoscopic examination of grafted intestine may be an effective diagnostic tool to detect the rejection phenomenon at an early stage, as well as a simple tool to use for postoperative follow-up in combination with pathological examination.