Intestinal transplantation: Laboratory experience and report of a clinical case

Abstract The experimental intestinal transplantation in our laboratory and elsewhere is briefly reviewed. Replantation of the entire jejunoileum is compatible with long-term survival of experimental animals. Lymphatic pathways severed during the procedure fully regenerated within a few weeks. Contrary to the implication of earlier studies on this subject, it is now believed that intestinal allografts are rejected in the same manner as other organs, and the rejection response is definitely mitigated by immunosuppressive drugs. There is no conclusive evidence of a graft versus host reaction despite the fact that transplantation of the entire jejunoileum represents a large antigenic mass and transplantation of many mesenteric lymph nodes. The time necessary for regeneration of lymphatic pathways after allotransplantation is different from that after replantation. In an eight year old boy with surgical removal of the entire jejunum and ileum, repeated problems with infection at catheter sites precluded intravenous feeding after four months. A 3 foot length of terminal ileum from his mother (a class B match) was transplanted, both ostia being opened as mucous fistulas to the abdominal wall. On the seventh day the recipient was explored because of the necrotic appearance of the stomas and a perforated duodenal ulcer. The allograft was precariously perfused and of questionable viability. It was removed to forestall possible further intraabdominal complications. Microscopic examination revealed extensive ischemic necrosis. The large vessels were open but the small vessels contained little blood. It was the opinion of the pathologist that the alterations found represented acute rejection, but we believe that limited arterial perfusion may have contributed substantially to the atrophic changes observed.