Segmental living related small bowel transplantation in adults

The advent of small bowel transplantation has provided selected patients wi th chronic intestinal irreversible failure with a physiologic alternative t o total parenteral nutrition. Recently a standardized technique for living related small bowel transplantation (LR-SBTx) has been developed. Three pat ients with short bowel syndrome underwent LR-SBTx at our institution. All d onors were ABO compatible with a good human leukocyte antigen match. A segm ent of 180 to 200 cm of ileum was harvested and transplanted with its vascu lar pedicle constituted by the ileocolic artery and vein. The grafts were t ransplanted with a short cold and warm ischemia time. The immunosuppression regimen consisted of oral FK-506, prednisone, and intravenous induction wi th atgam. Serial biopsies of the intestinal grafts were performed to evalua te rejection or viral infections. The postoperative course was uneventful f or all donors. All of the recipients are currently alive and well. Two of t hree patients are off total parenteral nutrition and tolerating an oral die t with no limitations on daily activity. In the third patient, the graft wa s removed 6 weeks after transplantation. At the time of enterectomy, no tec hnical or immunologic complications were documented. Absorption tests for D -xylose and fecal fat studies M ere performed showing functional adaptation of the segmental graft. All biopsies were negative for acute rejection. A well-matched segmental ileal graft from a living donor can provide complete rehabilitation for patients with short bowel syndrome. Our initial experie nce suggests that the risk of acute rejection and infection is greatly redu ced compared to cadaveric bowel transplantation. Further clinical applicati on of this procedure is warranted.