S3030 Safety and Efficacy of Teduglutide Therapy for Management of Short Bowel Syndrome After Intestinal Transplantation

Abstract

Introduction: Intestinal transplantation is a rare surgical procedure performed on patients with severe short bowel syndrome, characterized by inadequate intestinal absorption. Teduglutide, an intestinotrophic drug, increases patients’ intestinal absorption. This case study examines treatment courses of three short bowel syndrome patients beginning teduglutide treatment after intestinal transplantation. Case Description/Methods: 28 data points were collected regarding three intestinal allograft recipients’ teduglutide therapy treatment course. Two patients underwent solitary small intestine transplant, one underwent multivisceral transplant. Biopsy of two patients showed acute and chronic rejection of intestinal allograft; one patient had flattened intestinal villi. Teduglutide aimed to mitigate intestinal insufficiency secondary to rejection or explant-caused short bowel syndrome. All patients were on total parenteral nutrition. Total parenteral nutrition reduction began after a mean of 6.1 (range: 1.4–14.7) months on teduglutide. All patients’ diarrhea improved. Two patients were hospitalized on teduglutide: one for unrelated complications, the other for nausea and vomiting managed by inpatient total parenteral nutrition and ceasing teduglutide. Two patients experienced fluid overload, managed by total parenteral nutrition reduction. No other teduglutide-related complications were reported. Two patients had colonoscopies performed before and after treatment began. No patient was diagnosed with colon polyps, intestinal obstruction, or acute rejection during treatment. One patient developed chronic kidney disease secondary to immunosuppression; teduglutide was stopped upon dialysis initiation and resumed following stabilization. All patients are alive for a mean of 42.6 (range: 4.3–81.0) months since beginning teduglutide. Discussion: Teduglutide was safe and effective in managing our cohort’s short bowel syndrome post-intestine transplant. Teduglutide-linked complications were limited to fluid overload. No evidence of additional complications was found.