Small intestinal transplantation in nonhuman primates.
Small intestinal transplantation represents a potentially therapeutic procedure for individuals with short gut syndrome. The purpose of this study was to develop a model for small intestinal transplantation in primates that is: technically feasible without microsurgery; consistent in the prevention of allograft rejection; functional in terms of nutrient absorption; and compatible with harvest for multiple organ procurement. First, autotransplantations on four rhesus monkeys were performed in order to study a variety of harvesting techniques and vascular anastomoses. Then, a study was performed with 14 heterotopic allotransplants in 4 baboons and 10 rhesus primates. The successful donor model consisted of division of the pancreas, harvesting the small bowel with a superior mesenteric artery and portal vein pedicle. The allograft vascular pedicle was anastomosed to the recipient's common iliac vessels in end-to-side fashion. The graft was transplanted as an out-of-continuity loop, both ends being exteriorized as stomas providing access for absorption studies and biopsy. Three immunosuppressive regimens were tested: (1) cyclosporine A (CyA) 20 mg/kg/d, solumedrol (SML) 2 mg/kg/d, and graft irradiation (150 rad) (n = 4); (2) CyA 20 mg/kg/d and SML 2 mg/kg/d (n = 3); and (3) CyA 40 mg/kg/d, SML 2 mg/kg/d, and azathioprine 5 mg/kg/d (n = 3). There were 4 deaths due to technical error in the first 24 hours. Weekly graft biopsy, serum CyA levels, complete blood count, and automated 24-channel serum analysis were performed. Grafts surviving greater than 14 days underwent absorption study via luminal perfusion with sucrose, maltose, dextrose, Pregestimil, xylose, and cyclosporine.(ABSTRACT TRUNCATED AT 250 WORDS)
Hale
D A
DA
General and Plastic Surgery Services, Walter Reed Army Medical Center, Washington, DC.
Waldorf
K A
KA
Kleinschmidt
J
J
Pearl
R H
RH
Seyfer
A E
AE
D000818:Animals; D004040:Dietary Carbohydrates / Q000378:metabolism; D004195:Disease Models, Animal; D006085:Graft Survival / Q000276:immunology; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000637:transplantation*; D008253:Macaca mulatta; D010215:Papio; D010865:Pilot Projects; D012778:Short Bowel Syndrome / Q000378:metabolism / Q000601:surgery*; D014182:Transplantation, Autologous; D014183:Transplantation, Heterologous
D004040:Dietary Carbohydrates; D007166:Immunosuppressive Agents