Low infectious complications in segmental living related small bowel transplantation in adults

Clinical small bowel transplantation (SBTx) has been associated with a high rate of infectious complications. Laparotomy, preservation injury, abnorma l motility, lymphatic disruption, aberrant systemic venous drainage, reject ion and antibiotic therapy could all be implicated in the etiology of these complications. In addition to the underlying disease, total parental nutri tion could determine infections and liver impairment. Recently, standardize d techniques for segmental living related SBTx (LR-SBTx) have been develope d. This technique allows reduction of some of these factors, thus resulting in a reduced incidence of infections. We report the infectious complicatio ns observed in 3 patients with short bowel syndrome treated with LR-SBTx at our institution. A segment of 180-200 cm of ileum was transplanted with a neglectably short cold ischemia time (CIT). The donor bowel was de contamin ated. Oral tacrolimus, prednisone and IV induction with ATG were used for i mmunosuppression. Blood, stool, urine, sputum and peritoneal fluids were co llected and cultured as a routine surveillance. All recipients are alive wi th a current follow-up time up to 21 months. No bacterial infections were o bserved during the post-transplant period. One patient developed cytomegalo virus (CMV) enteritis 4 months after LR-SBTx and was treated successfully w ith IV ganciclovir. In our limited experience, LR-SBTx is associated with a low infection rate. This could be due to optimal graft decontamination, sh ort CIT and to the reduced incidence of rejection and lower immunosuppressi on used in this immunologically well-matched combination.