Oral beclomethasone therapy for recurrent small bowel allograft rejection and intestinal graft-versus-host disease

Abstract

INTESTINAL transplantation is an accepted therapy for short bowel syndrome in individuals with life-threatening complications of total parenteral nutrition (TPN). The primary problem preventing wider application of small bowel transplantation electively is the high levels of immunosuppression required to prevent rejection of the small bowel graft and the 20% incidence of graft loss due to rejection despite these high levels. Oral beclomethasone has been used experimentally in the treatment of inflammatory bowel disease and intestinal graft-versus-host disease (GVHD) associated with bone marrow transplantation. It acts primarily as a topical steroid without high levels of systemic absorption that would lead to adrenal suppression. There are currently no reports in the literature describing the use of beclomethasone in small bowel transplant recipients. The striking similarity between GVHD and acute small bowel allograft rejection histologically suggests beclomethasone may have a role in treating and preventing recurrent acute rejection. Herein we present the results of oral beclomethasone treatment in three small bowel transplant recipients who had multiple episodes of acute small bowel rejection and one with GVHD.