Two Cases of Living-Related Intestinal Transplantation

Abstract

We recently performed living-related small bowel transplant in two patients. The first patient was a 14-year-old boy with total parenteral nutrition (TPN)-dependent short-bowel syndrome associated with hypoganglionosis. He received a bowel graft from his 43-year-old mother. The second patient was a 27-year-old female who had undergone massive enterectomy due to volvulus. She underwent living-related bowel transplantation from her 57-year-old mother. In both cases, blood types were ABO identical, cytotoxic cross matches were negative, and cytomegalovirus status was positive to positive in both cases. Up to one third of the donor bowel was harvested from the distal ileum. The graft vessels were connected to infrarenal aorta and inferior vena cava. The immunosuppressive regimen consisted of daclizumab, tacrolimus, and steroids. The first patient developed progressive acute cellular rejection on postoperative day 9, requiring OKT-3 therapy. Two months after transplantation, he was weaned off TPN, tolerating oral intake with a fully functioning graft. The second patient was weaned off TPN on day 29 with a functioning graft. Her metabolic disorder dramatically improved. This patient developed indeterminate acute cellular rejection on day 111, which was successfully treated with bolus injections of steroid. Both donors had no complications; they were discharged on day 10. Living-related intestinal transplantation can be a treatment option for patients with short-bowel syndrome.