Improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation (one case report)

Abstract

Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation. Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation. Ostomy of graft was performed instead of intestinal anastomosis during the operation. The anastomosis of graft and autologous intestine was performed 8 months after transplantation. Hospital and follow-up data of the patients were analyzed retrospectively. Result The functions of liver and small bowel recovered smoothly after operation. Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver. In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery. Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation. The patient was followed up for nearly 3 years with good quality of life without rejection and infection. Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen. Key words: Liver transplantation; Intestine transplantation; Short bowel syndrome; Graft rejection