[Preliminary experience with partial tolerance protocol in small bowel transplantation]

Abstract

Objective: To report the preliminary experience of 4 cases of small bowel transplantation.

Methods: Thirty microgram of Campath 1H was infused during the small bowel transplantation. The patients received 1 gram of Solu-Medrol followed by the Campath 1H and another gram of Solu-Medrol before reperfusion. The infusion of tacrolimus started just after reperfusion. The route of tacrolimus administration was transferred from vein to gut tract gradually, the tacrolimus trough levels were aimed at 10-15 microg/L within the first 3 postoperative months, 5-10 microg/L at 4-6 months post-operation and taped to 5 microg/L thereafter.

Results: Two of these 4 cases survived more than one year. The follow-ups of other 2 patients were 6 and 2 months respectively. Three episodes of IND to mild acute rejection verified by pathology through routine ileoscopical biopsy were found at 1-3 months post-operation, anther 3 episodes of IND to mild acute rejection verified during at 4-6 months post-operation and one episode of moderate acute rejection found at 7-12 months post-operation. The patients totally recovering after a low-dose steroid or bolus steroid were given respectively. The grafted intestine achieved an excellent function. And the patients discontinued TPN at 2-3 weeks post-operation respectively and lived on a normal oral intake to maintain their nutritional status.

Conclusions: The partial tolerance steroid-free protocol of combining Campath 1H induction with a low-dose monotherapy of tacrolimus can effectively control the graft rejection in small bowel transplantation. And the grafted intestine regains an excellent function.