Pediatr Surg Int (1997) 12:367-369 © Springer-Verlag 1997 B. H. Giiven~ • T. Salman • B. Tokar • E. Siirmen T. Altu~ " A. (yelik Fetal intestinal transplant as an accessory enteral segment Accepted: 6 June 1996 Abstract Fetal tissue transplantation has gathered considerable interest among researchers dealing with organ transplantation. A large number of studies con- cerning fetal intestinal transplantation have been pub- lished in the past 2 decades, almost all of them aiming to determine the feasibility of a properly functioning fetal transplant in continuity with the host's own enteral system. This study was designed to determine the ab- sorptive capacity of the neogut in vivo, without ana- stomosing the transplant to the host's intestine, and to evaluate its use as an accessory enteral segment. In- testinal segments taken from Wistar albino fetuses were transplanted subcutaneously into the abdominal wall of 20 Sprague-Dawley rats. Immunosuppression was maintained by daily cyclosporin A (Cy A) 10 mg/kg injections s.c. and evaluated by determination of serum Cy A level and T-helper/T-suppressor cell ratio. The neogut was converted into a Thiry-Vella loop 2 weeks after transplantation. A test solution composed of 20% glucose and Trophamine was perfused via the stomas; glucose and amino acid absorption gradients were cal- culated. The gamma-glutamyl transferase (GGT) activ- ity and mitotic index of the neogut were determined. Results were compared to those obtained from the host. There was no significant difference (P > 0.05) in glucose absorption between the neogut and the host tissue. Amino acid absorption and specific GGT activity were Presented at the 39th Annual International Congress of the British Association of Paediatric Surgeons, Leeds B. H. Gfiven~ ([]) Selami Cesme Guzel Sok. 16/14, TR-81030 Kiziltoprak, Istanbul, Turkey B. H. Gfiveng. T. Salman-B. Tokar-E. Sfirmen. T. Altu~' A. ~elik Department of Pediatric Surgery, University of Istanbul, Istanbul School of Medicine, Istanbul, Turkey significantly less (P < 0.01) in the neogut. There was no significant difference (P > 0.05) between neogut and host intestine in mitotic index. Our data support the idea of using a transplanted fetal intestinal segment as an accessory feeding route. Key words Fetal tissue transplantation • Small intestinal transplantation Introduction The energy requirements of a growing child are best met by a properly functioning intestinal system. It has been established that the loss of more than 80% of the small intestine is incompatible with life. Intravenous admin- istration of vital nutrients means survival for the patient suffering from short-bowel syndrome (SBS). During this supplementary treatment, the intestine is expected to adapt to its new physiological state. Parenteral nutrition, on the other hand, is associated with serious complica- tions such as thrombosis, sepsis, and liver impairment in addition to psychological side effects and high cost [3, 15, 16]. Intestinal transplantation, on the other hand, has presented even more complicated problems. Numerous efforts have shown that clinical success is elusive while problems such as rejection, graft-versus-host disease, and sepsis due to immunosupression await solution [1, 8, 14]. The search for alternative treatments has led re- searchers to investigate the use of fetal tissues in trans- plantation. Like many other investigators who have responded to Zinzar et al.'s original paper [20], we have shown in previous studies that an avascular fetal in- testinal segment may survive and continue to grow with an intact lumen in the subcutaneous space of a syngeneic host [13]. Deutsch et al. [2] and Kellnar et al. [5] suc- ceeded in anastomosing the neogut to the host's own enteral system. Studies accomplished so far have shown that animals with such transplants are unable to eat