Glycyl-glutamine-enriched long-term total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig

Background, Improvements in immunosuppression, operative procedure, and pos ttransplant management have made clinical small bowel transplantation (SBT) feasible. Ischemia and reperfusion injury, total parenteral nutrition (TPN ), and devoidment of enteral feeding lead to graft atrophy, gut barrier dys function, and bacterial translocation. Glutamine (GLn) is the principal fue l for the enterocyte. The influence of Gin dipeptide-supplemented TPN, espe cially long-term TPN, on intestinal graft permeability and bacterial transl ocation is not clear following SET in the large animal model. Therefore, we studied the effect of glutamine dipeptide, glycyl-glutamine (Gly-Gln), on bacterid translocation following SET in the pig, which has a physiology sim ilar to humans. Materials and methods. The outbred pigs underwent segmental small bowel aut otransplantation and were divided into two groups. In the STPN group (n = 5 ), the animal received standard TPN devoid of Gly-Gln for 28 days. In the G TPN group (n = 5), the animal received isonitrogenous (0.3 g/kg.day) and is ocaloric (33 kcal/kg.day) TPN solution with 2% Gly-Gln for 28 days. Results. At the end of the experiment, Gly-Gln-enriched TPN could maintain the plasma Gin level graft mucosal Gin and protein concentrations, and skel etal muscle Gin and protein concentrations. Gly-Gln-enriched TPN significan tly decreased the bacterial number of mesenteric lymph nodes in the liver a nd spleen and intestinal permeability to Tc-99m-DTPA. There were no signifi cant differences in body weight gain. Conclusions. The Gly-Gln-enriched long-term TPN may maintain the plasma Gln level, mucosal and muscle Gin, and protein concentrations and attenuate th e intestinal permeability to Tc-99m-DTPA and bacterial translocation follow ing small bowel transplantation ill the pig. (C) 1999 Academic Press.