Postoperative enteral feeding following small bowel transplantation in pigs: Effects on bacterial translocation and pulmonary infection rate

Objective: To examine the effects of a non-elemental liquid diet on nutritional status, composition of the bowel flora, rate of intestinal translocation and pulmonary infectious after transplantation of the small bowel in pigs. Design: Randomized controlled study. Material: 30 female Large White pigs. 8 animals were not operated on (normal controls). 17 animals underwent total orthotopic small bowel allotransplantation and were then randomised to receive: group 1 (n = 6) cyclosporin A 15 mg/kg i.v. and commercial chow 'ad libitum'; group 2 (n = 6) cyclosporin A 15 mg/kg i.v. and enteral feeding providing 34.5 ± 6.5 kcal/kg; group 4 (n = 5) commercial chow 'ad libitum'. A further group (3, n = 5) underwent orthotopic autotransplantation and received the same regimen as group 1. Animals in group 4 were killed on day 8, and the rest on day 29. Main outcome measures were signs of rejection and graft versus host disease, luminal bacterial overgrowth, evidence of bacterial translocation to mesenteric lymph nodes, liver, spleen and lungs, evidence of pulmonary infection and nutritional status. Results: All animals in group 4 showed signs of acute rejection. There was a significant overgrowth of both aerobic and anaerobic bacteria in all 3 groups after allotransplantation compared to normal controls. The counts of anaerobic bacteria were significantly lower in the entrally compared to the 'ad libitum' nutrition group. Bacterial translocation was similar in autografted and allotransplanted animals. Pulmonary infection rate was significantly lower in entrally fed animals, and weight loss as well. Conclusion: Enteral feeding prolonged up to one month significantly reduced the rate of pulmonary infection and allowed a better nutritional status in recipients of small bowel allograft. It did not modify either the luminal bacterial overgrowth or the intestinal translocation.