S3551 Factors Related to Patient Outcomes Following Intestinal Transplant Surgery for Gunshot-Related Short Bowel Syndrome

Abstract

INTRODUCTION: We discuss factors that may have contributed to variations in patient outcome after intestinal transplant surgery secondary to short bowel syndrome (SBS). Trends in this research are relevant for gastroenterologists considering intestinal transplant surgery for applicable patients. CASE DESCRIPTION/METHODS: A retrospective chart review was conducted for two intestinal transplant patients at a large urban medical center. Both patients underwent intestinal transplants secondary to SBS after small bowel resections for gunshot related injury (GSW). A 22-year old male underwent a small bowel and colon resection after injury from GSW, leading to the development of SBS. Eleven months later, he underwent an intestinal transplant surgery with a terminal ileostomy created. No co-morbidities were noted before transplant surgery; after transplant surgery, the patient developed acute kidney injury (AKI) and anemia. He was treated with Cidofovir and thymoglobulin for acute cellular and humoral transplant rejection via adenovirus enteritis at five years and again at eight years post-transplant. Complications secondary to acute transplant rejection led to enterectomy nine years post-transplant. A 37-year old male underwent a small bowel and right hemicolectomy after injury from GSW, leading to the development of SBS. Eight years later, he underwent an intestinal transplant surgery from a high-risk donor with a proximal jejunojejunostomy, distal ileo-colostomy, and ileostomy created. Surgical complications included congestion of graft and bowel edema. Co-morbidities before transplant surgery included history of DVT, cholecystectomy, and smoking history; after transplant surgery, the patient developed AKI, anemia, and inferior vena cava/superior mesenteric vein stenosis. The patient was treated with Cidofovir, plasmapheresis, and intravenous immunoglobin (IVIG) for acute cellular and humoral transplant rejection via adenovirus enteritis a month post-transplant. The patient passed away from complications secondary to acute transplant rejection eleven months post-transplant. DISCUSSION: Variations in patient outcome post-intestinal transplant are due to multi-factorial causes such as pre-transplant comorbidities, alterations in transplant surgical procedure, and severity of surgical complications. Further research is needed to examine the contribution of immunosuppression regimens, viral, social, and age-related factors on outcomes in intestinal transplantation.