A morphological study of intestinal transplantation and the effect of donor graft pretreatment on intestinal allograft survival

The interest in intestinal transplantation is stimulated by the recent technical success of Lellihei in transplanting the entire intestine in dogs. The ability to transplant intestine would certainly find a useful place in the surgeons' armamentarium in treating a condition which requires excision of the entire small intestine. A morphological study of intestinal mucosal changes during rejection is presented in this thesis. The intestinal mucosa was found to reject in a fashion very similar to kidney and other organ allografts with the same general survival time. Clubbing, round cell infiltration and ischemic changes (lifting of the epithelium) are characteristic changes observed during rejection. Vascular damage and occlusion of the small vessels with platelet thrombi and fibrin deposition seem to have a significant role to play in the rejection process, as shown both in the carbon injection study and electron-microscopic studies presented. Immunosuppressive studies presented show that survival of intestinal allograft can be prolonged by conventional immunosuppressive agents (Anti-thymocytic-serum and immuran). However, it seems that intestine is more difficult to immunosuppress than kidney allografts. Donor graft perfusion with ATG during operation does not seem to have any appreciable effect ln the survival of intestinal allografts