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.