Leakage of intraluminal low molecular weight polyethylene glycol as a marker of small bowel transplant rejection

To facilitate early detection of small bowel allograft rejection, we correlated transluminal leakage of low molecular weight polyethylene glycol (PEG) with the development of allograft rejection. Vascularized allogeneic and syngeneic jejunal transplants were performed in rats, without immunosuppression. A control group underwent creation of jejunal Thiry-Vella fistulas of similar length. Jejunal segments were perfused with a physiologic solution containing [³H]-PEG-900. At the end of an equilibrium period, an urinary bladder aspirate was collected and [³H]-PEG-900 measured by scintillation counting. Results are expressed as disintegrations per minute per 100 μL urine. Histologic examinations were performed at all experimental time points. Two days following transplantation, urinary PEG levels were elevated in both allogeneic and syngeneic groups (3943±935 and 4007±1164, respectively). Four days after the transplant, syngeneic urine PEG levels decreased to 581±159, and were not significantly different (P>.05) from Thiry-Vella controls (635±145). Syngeneic levels remained at this low level for the rest of the experiment. The allogeneic group continued to show significantly higher levels (P<.05) compared with syngeneic and Thiry-Vella groups from day 4 until the end of the experiment. These elevated levels most likely represented the development of rejection, preceding the first significant histologic signs of rejection, which were found at six days post-transplant. Detection of transluminal leakage of low molecular weight PEG may be a useful adjunct in monitoring for small bowel transplant rejection.