Comparison of rejection rate and functional outcome of small bowel transplantation alone or in conjunction with the ileocecal valve versus combined small and large bowel transplantation

Preservation of the ileocecal valve improves absorptive function and decrea ses the amount of small bowel needed for survival in patients with short gu t syndrome. We compared the results of small and large bowel transplant (SL BTx), small bowel transplant only (SBTx), and SBTx with the ileocecal valve (ICVTx) in a porcine model. Total enterectomy was performed on 18 Yorkshir e-Landrace pigs followed by orthotopic SBLTx (n = 6), SBTx (n = 6), and ICV Tx (n = 6). A jejunostomy and an ileostomy were constructed for biopsies. O verall mean survival was 17 d with no statistically significant difference between groups. Rejection was seen in 6/6 SLBTx, 4/6 SBTx, and 4/6 ICVTx re cipients. Acute rejection was seen in 84.3% of SLBTx, 52.3% of SBTx, and 42 .5% of the ICVTx mucosal biopsy samples. Two cases of intra-abdominal infec tion were in the ICVTx group only. Weight loss was 147 g/d in the SLBTx gro up, 643 g/d in the SBTx group, and 393 g/d in the ICVTx group. While the fu nctional outcome after SLBTx and ICVTx was noticeably better than the SBTx group, the increased rejection and intra-abdominal infection rates make tra nsplanting the large bowel or the ileocecal valve a less attractive clinica l option.