title: [Outcome of isolated small bowel transplantation in adults: experience from a single Italian center].
abstract: 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.
authors.affiliation: Centro Trapianti di Fegato e Multiviscerale, Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Italy. f.diben@virgilio.it
authors.forename: F
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: M
authors.initials: M
authors.lastname: Masetti
authors.forename: N
authors.initials: N
authors.lastname: Cautero
authors.forename: N
authors.initials: N
authors.lastname: De Ruvo
authors.forename: C
authors.initials: C
authors.lastname: Quintini
authors.forename: S
authors.initials: S
authors.lastname: Sassi
authors.forename: F
authors.initials: F
authors.lastname: Di Francesco
authors.forename: T
authors.initials: T
authors.lastname: Diago Usò
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.forename: G
authors.initials: G
authors.lastname: Molteni
authors.forename: B
authors.initials: B
authors.lastname: Begliomini
authors.forename: A
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: L
authors.initials: L
authors.lastname: De Pietri
authors.forename: A
authors.initials: A
authors.lastname: Bagni
authors.forename: A
authors.initials: A
authors.lastname: Merighi
authors.forename: M
authors.initials: M
authors.lastname: Codeluppi
authors.forename: M
authors.initials: M
authors.lastname: Girardis
authors.forename: G
authors.initials: G
authors.lastname: Ramacciato
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents