Isolated intestinal transplantation for intestinal failure

OBJECTIVE: Parenteral nutrition sustains life in patients with intestinal f ailure. However, some experience life-threatening complications from parent eral nutrition, and in these individuals intestinal transplantation may be Lifesaving. METHODS: This is a retrospective review of 28 consecutive isolated small bo wel transplants performed in eight adults and 20 children between December 1993 and June 1998 at the University of Nebraska Medical Center. RESULTS: The I-yr patient and graft survivals were 93% and 71%, respectivel y. The causes of graft loss were hyperacute rejection (n = 1), acute reject ion (n = 5), vascular thrombosis (n = 1). and patient death (n = 1). The me dian length of time required until full enteral nutrition was 27 days. All 28 patients have experienced acute rejection of their small bowel grafts an d rejection led to graft failure in five. Jaundice and/or hepatic fibrosis was present preoperatively in 17 of the 28 recipients and hyperbilirubinemi a was completely reversed in all patients with functional grafts within 4 m onths of transplantation. Three patients developed posttransplant lymphopro liferative disease (11%). Three recipients developed cytomegalovirus enteri tis and all were successfully treated. CONCLUSIONS: Patient survival after intestinal transplantation is comparabl e to parenteral nutrition for patients with intestinal failure. Better immu nosuppressive regimens are needed to decrease the risk of graft loss from a cute rejection. The incidence of posttransplant lymphoproliferative disorde r is higher after intestinal transplantation than after other solid organ t ransplants and the risk of cytomegalovirus enteritis is low with the use of cytomegalovirus seronegative donors. Liver dysfunction in the absence of e stablished cirrhosis can be reversed. (Am J Gastroenterol 2000;95: 1506-151 5. (C) 2000 by Am. Cell. of Gastroenterology).