[Outcome of isolated small bowel transplantation in adults: experience from a single Italian center].
OBJECTIVE
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 graft removal (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 thymoglobulin (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.


CONCLUSIONS
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.
Di Benedetto
F
F
Centro Trapianti di Fegato e Multiviscerale, Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Italy. f.diben@virgilio.it
Lauro
A
A
Masetti
M
M
Cautero
N
N
De Ruvo
N
N
Quintini
C
C
Sassi
S
S
Di Francesco
F
F
Diago Usò
T
T
Romano
A
A
Dazzi
A
A
Molteni
G
G
Begliomini
B
B
Siniscalchi
A
A
De Pietri
L
L
Bagni
A
A
Merighi
A
A
Codeluppi
M
M
Girardis
M
M
Ramacciato
G
G
Pinna
A D
AD
D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007410:Intestinal Diseases / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
D007166:Immunosuppressive Agents