title: Isolated small bowel transplantation outcomes and the impact of immunosuppressants: Experience of a single transplant center.
abstract: OBJECTIVE
  To investigate patient and graft outcomes in isolated small bowel transplant (SBTx) recipients and immunosuppressant induction agent impact on outcomes.
  
  
  METHODS
  A retrospective review of the perioperative data of patients who underwent SBTx transplant during an 8-year period was conducted. The intraoperative data were: patient demographics, etiology of short gut syndrome, hemodynamic parameters, coagulation profiles, intraoperative fluid and blood products transfused, and development of post-reperfusion. The postoperative data were: hospital/intensive care unit stays, duration of mechanical ventilation, postoperative incidence of acute kidney injury, and 1-year patient and graft outcomes. The effects of the three immunosuppressant induction agents (Zenapax, Thymoglobulin, Campath) on patient and graft outcomes were reviewed.
  
  
  RESULTS
  During the 8-year period there were 77 patients; 1-year patient and graft survival were 95% and 86% respectively. Sixteen patients received Zenapax, 22 received Thymoglobulin, and 39 received Campath without effects on patient or graft survival (P = 0.90, P = 0.14, respectively). The use of different immune induction agents did not affect the incidence of rejection and infection during the first 90 postoperative days (P = 0.072, P = 0.29, respectively). The Zenapax group received more intraoperative fluid and blood products and were coagulopathic at the end of surgery. Zenapax and Thymoglobulin significantly increased serum creatinine at 48 h (P = 0.023) and 1 wk (P = 0.001) post-transplant, but none developed renal failure or required dialysis at the end of the first year.
  
  
  CONCLUSIONS
  One-year patient and graft survival were 95% and 86%, respectively. The use of different immunosuppressant induction agents may affect the intraoperative course and short-term postoperative morbidities, but not 1-year patient and graft outcomes.
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Ibtesam A
authors.initials: IA
authors.lastname: Hilmi
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Planinsic
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Ramona
authors.initials: R
authors.lastname: Nicolau-Raducu
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Daniela
authors.initials: D
authors.lastname: Damian
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Khafaji
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States.
authors.forename: Kareem
authors.initials: K
authors.lastname: Abu-Elmagd
keywords: Campath; Immune induction agents; Outcomes; Small bowel transplant; Thymoglobulin; Zenapax