Small intestinal transplantation is the only treatment to wean patients of intestinal failure from complications due to total parenteral nutrition. Because of the complexity of the surgery and the unique characteristic of grafts, there are difficulties in choosing immunosuppresants, adjusting the serum level of drugs, nutrition support and managing complication such as rejection, graft versus host disease and infection.
Our institution is the first medical center in Taiwan performing small intestinal transplantation. We have performed the surgery on 13 patients with intestinal failure, and the success rate is 100%. The protocol indicated the use of rabbit antithymocyte globulin (rATG) as induction agent and followed by tacrolimus monotherapy, and the five-year survival rate is 61%.
In this article, we reviewed the cases of our institution and the published literatures to discuss the preand post-operational immunosuppression therapy and the management of the post-operational complications.