Living-Donor Small Bowel Transplantation: Experience of Three Cases

Summary

A living-donor small bowel transplantation (SBT) was performed in three cases with short-bowel syndrome. In all cases, the donor was the patient’s mother and blood type combinations were identical. The distal 100 cm, 120 cm, and 140 cm of the ileum were resected for the grafts. The donors were discharged from the hospital on postoperative days 15, 16, and 14, respectively. All had mild tenesmus, which resolved 6 months after the operation, but have had no nutritional problems. The three recipients were a boy aged 2 years and 6 months, a girl aged 4 years and 5 months, and a boy aged 3 years and 5 months.

Immunosuppression consisted of tacrolimus, steroids, and azathioprine or cyclophosphamide. Induction treatment with a 3-day course of OKT3 or a 6-month course of daclizumab was given to the second and third case, respectively. The first patient experienced four episodes of rejection, and died of Pneumocystis carinii pneumonia 16 months after transplantation. The autopsy findings showed chronic rejection of the intestinal graft. The second recipient left the hospital completely weaned from total parenteral nutrition (TPN),but she later was readmitted with severe rejection. The graft had developed chronic rejection and was removed. This patient received a cadaveric SBT 8 months after removal of the living-donor graft. The third recipient had one episode of mild rejection, which was easily treated with a steroid bolus. He was discharged from hospital completely weaned from TPN 5 months after transplantation.

In our experience, harvesting of the distal ileum as an intestinal graft can be performed safely. Rejection is still the main obstacle to a successful outcome.