2574 15 Years Out, a Small Bowel Transplant That Defeated the Odds

Abstract

INTRODUCTION: Small bowel transplant has been shown to have good short-term patient survival rates, however long-term rates are often dismal. We present one of the longest documented survivals of a small bowel transplant. CASE DESCRIPTION/METHODS: A 69-year-old female underwent multiple surgical interventions due to recurrent small bowel obstruction during her 3rd and 4th decades of life. Unfortunately, this resulted in a short gut syndrome. At the age of 54, she underwent an isolated small bowel transplant. She had a prolonged post-transplant hospitalization requiring 11-month stay. Despite being compliant with mycophenolate and tacrolimus, she had multiple admissions for sepsis and volume depletion from her ileostomy losses. Due to nephrotoxicity form immunosuppressive drugs, she developed ESRD requiring HD in the last 3 years. Despite the challenges, she has continued to live independently. DISCUSSION: Isolated small intestine transplantation is a rare procedure in adult patients. This continues to be the last measure for intestinal failure in patients who cannot tolerate or receive total parental nutrition. Some of the common causes of intestinal failure in adults include bowel ischemia, volvulus, trauma, and Crohn's disease. Over the last two decades, the success rate of small bowel transplantation has improved due to advancements in immunosuppression, refined surgical techniques, and better post-transplantation care. However, despite this glimmer of hope, both the procedure and post-transplanted state are associated with high morbidity and mortality rates. Post-transplant complications include opportunistic infections due to immunosuppressive agents, graft rejection and surgical complications including anastomotic leaks. Graft rejection appears to be the most common and at times difficult to manage complication, though this too has improved. Today, patient survival at one year is close to 85%, 5 years at 61% but at 15-years survival is unfortunately at 35%. Our patient has no signs of graft rejection after 15 years post-transplant and her liver synthetic function remains normal.