Metabolic Effects of Systemic Venous Drainage in Small-Bowel Transplantation

Abstract

In vascularized transplants of the small bowel, venous outflow from the intestinal graft may be conveyed into either the portal or the systemic venous circulation. Studies on a variety of organ allografts (SAKAI 1970; BOECKX et al. 1975), including small-bowel allografts (KORT et al. 1973; SCHRAUT et al. 1983), have suggested that portal venous drainage confers immunologic benefits which favor prolonged allograft survival. These benefits appear to be minor, however, and may not be sufficient to justify the use of portal drainage in preference to systemic venous drainage in intestinal transplantation (SCHRAUT et al. 1985). Portal drainage, however, reestablishes the physiologic route of venous outflow, whereas systemic drainage creates a partial mesocaval shunt, the metabolic consequences of which have not been studied in detail. Therefore, using the rat model in orthotopic small-bowel transplantation, we compared the metabolic changes following transplantation with portal and with systemic venous drainage. Changes in body weight, blood ammonia levels, serum triglycerides, protein and albumin, maltose absorption, and liver weight were the parameters studied.