title: Long-term outcome of living related renal transplantation in a patient with short bowel syndrome.
abstract: Short-bowel syndrome (SBS) is defined as the malabsorptive state that occurs after extensive resection of the small intestine. In patients with SBS, oral administration of drugs usually becomes difficult because of the severity of intestinal failure. We describe a successful living related renal transplantation (LRRTx) in an 18-year-old male with SBS. Shortly after birth, the patient developed necrotizing enterocolitis requiring massive resection of the small intestine, which resulted in SBS. At seven years of age, the patient developed proteinuria and was diagnosed as focal segmental glomerulosclerosis (FSGS). His kidney function was gradually deteriorated toward the end-stage renal failure. The patient received LRRTx at age of 18 years. To evaluate the absorption capacity of the patient, we investigated pharmacokinetics of calcineurine inhibitors (tacrolimus and cyclosporine). The drug concentration, which is sufficient to provide effective immunosuppression, was achieved with cyclosporine, but not with tacrolimus. The patient therefore received a triple immunosuppressive therapy with oral cyclosporine, methyl-prednisolone and mycophenolate mofetil. To prevent both recurrent FSGS and rejection, we repeatedly analyzed the trough level and the pharmacokinetics of cyclosporine after LRRTx. The patient was successfully treated with oral immunosuppression for over 5 years, without hemodialysis. To our knowledge, this is the first report showing the long-term outcome of LRRTx treated with oral cyclosporine in a patient with SBS.
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University. FO11547/1
authors.forename: Ikuo
authors.initials: I
authors.lastname: Takeda
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sekiguchi
authors.forename: Yorihiro
authors.initials: Y
authors.lastname: Akamatsu
authors.forename: Kazushige
authors.initials: K
authors.lastname: Sato
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.forename: Keisei
authors.initials: K
authors.lastname: Fujimori
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D016572:Cyclosporine / Q000493:pharmacokinetics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011788:Quality of Life; D012778:Short Bowel Syndrome / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D016559:Tacrolimus / Q000493:pharmacokinetics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone