Small bowel transplantation. A life-saving option for selected patients with intestinal failure.
Thirty-seven patients were listed for small bowel transplantation; 16 were transplanted and 15 died while waiting for a donor. Cyclosporine (N = 6) or tacrolimus (N = 10) were used for immune suppression. Graft rejection rates were lower in the combined liver/small bowel grafts than the isolated intestinal transplants (1/7 vs 5/7; P < 0.01) All of the cyclosporine group have died; the median survival was 25.7 months with two patients living more than five years. The tacrolimus group had fewer infections and a shorter hospital stay. All but two are alive with a median survival of 13 months. Seven of eight long-term survivors are off intravenous feedings. We conclude that small bowel transplantation is a life-saving option for patients with intestinal failure who cannot be maintained on total parenteral nutrition.
Asfar
S
S
Multi-Organ Transplant Service, University Hospital, London, Ontario, Canada.
Atkison
P
P
Ghent
C
C
Duff
J
J
Wall
W
W
Williams
S
S
Seidman
E
E
Grant
D
D
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000637:transplantation*; D017093:Liver Failure / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D016559:Tacrolimus / Q000008:administration & dosage; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus