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Updated: Aug 6, 2026
Orthotopic Small Bowel Transplantation in Rats
Published on: November 6, 2012
Two cases of living-related intestinal transplantation
1Department of Pediatric Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. t-ishii@ped-surg.med.tojoku.ac.jp
Insights
Living-related intestinal transplantation offers a viable treatment for short-bowel syndrome. This study details successful small bowel transplants in two pediatric and adult patients, demonstrating graft function and improved quality of life.
Area of Science:
- Gastroenterology
- Transplantation Surgery
- Immunology
Background:
- Short-bowel syndrome (SBS) and massive enterectomy necessitate complex management, often including total parenteral nutrition (TPN).
- Living-related intestinal transplantation presents a potential solution for SBS patients when conventional treatments fail.
Observation:
- Two patients, a 14-year-old boy with hypoganglionosis-associated SBS and a 27-year-old female post-massive enterectomy, underwent living-related small bowel transplantation.
- Grafts were harvested from maternal donors, with ABO compatibility and negative crossmatches. Immunosuppression involved daclizumab, tacrolimus, and steroids.
- Both patients were successfully weaned off TPN, demonstrating graft function and improved metabolic status, despite experiencing acute cellular rejection episodes managed with specific therapies.
Findings:
- Successful engraftment and function were achieved in both living-related small bowel transplant recipients.
- Post-transplant rejection episodes were managed effectively, leading to long-term graft survival and TPN independence.
- Donors experienced no complications and were discharged promptly, highlighting the safety profile for living donors.
Implications:
- Living-related intestinal transplantation is a feasible and effective therapeutic option for select patients with SBS.
- This approach can significantly improve patient outcomes, enabling oral intake and resolving metabolic complications.
- Further research into optimizing immunosuppression protocols and donor selection may enhance outcomes in 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.
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