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

Area of Science:

• Transplantation immunology
• Gastroenterology
• Surgical innovation

Background:

• Small bowel transplantation (SBT) is a complex procedure with challenges in graft rejection.
• Effective immunosuppression is crucial for long-term graft survival and function.

Purpose of the Study:

• To evaluate a novel steroid-free immunosuppression protocol for small bowel transplantation.
• To assess the efficacy of Campath 1H induction and tacrolimus monotherapy in preventing graft rejection.

Main Methods:

• Four patients underwent small bowel transplantation with a protocol including Campath 1H induction and gradual tacrolimus administration.
• Tacrolimus trough levels were meticulously monitored and adjusted postoperatively.
• Steroid-free regimen with Campath 1H and low-dose tacrolimus was employed.

Main Results:

• Two of four patients survived over one year post-transplant.
• Graft rejection episodes (mild and moderate acute) were effectively managed with low-dose steroids.
• Successful engraftment led to excellent graft function, enabling discontinuation of total parenteral nutrition (TPN) within 2-3 weeks.

Conclusions:

• A steroid-free protocol combining Campath 1H induction with low-dose tacrolimus monotherapy is effective in managing small bowel transplant rejection.
• This immunosuppressive strategy promotes excellent graft function and patient recovery.