ORIGINAL ARTICLES   

Minerva Chirurgica 2005 February;60(1):1

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: Italian

Outcome of isolated small bowel transplantation in adult: experience from a single italian center

Di Benedetto F., Lauro A., Masetti M., Cautero N., De Ruvo N., Quintini C., Sassi S., Di Francesco F., Diago Usò T., Romano A., Dazzi A., Molteni G., Begliomini B., Siniscalchi A., De Pietri L., Bagni A., Merighi A., Codeluppi M., Girardis M., Ramacciato G., Pinna A. D.

Aim. Isolated small bowel transplantation is becoming the treatment of choice for adult patients with serious parenteral nutrition (PN) related complications: we report our three-year experience (December 2000-December 2003) from a single italian center (Modena-Italy), with one of the larger european series.
Methods. We transplanted 14 patients, with a previous mean PN course of 27 months and a mean 21-month post-transplantation follow-up (range 3-36 months), obtaining a one-year actuarial survival rate of 92.3% with no intraoperative deaths.
Results. We lost 1 patient (7.2%), died for post-transplantation overwhelming sepsis following Cytomegalovirus (CMV) enteritis. Thirteen patients are alive, with one-year actuarial graft survival rate of 85.1%: 1 patient underwent graftectomy (7.2%) for intractable severe acute rejection. Our immunosuppressive regimen was based on tacrolimus and 3 induction protocols: daclizumab (8 patients) with steroids, alemtuzumab (4 patients) and thymoglobuline (2 patients) without steroids. In 9 cases, we added sirolimus. Nine recipients experienced 22 episodes of acute cellular rejection (ACR), treated successfully in all cases but one. One patient (7.2%) was treated successfully for Post Transplant Lymphoproliferative Disease (PTLD) and is disease-free after 8 months.
Conclusion. Small bowel transplantation can achieve optimal results depending on appropriate immunosuppressive management and candidate selection, added to shorter ischemia time and careful donor and graft selection.