Teduglutide for intestinal failure following multivisceral transplantation complicated by graft rejection and PTLD: A...

Multivisceral transplantation (MVT) is an increasingly utilized option for patients with complex abdominal pathology. However, complications such as graft rejection and post-transplant lymphoproliferative disorder (PTLD) may result in recurrent intestinal failure and parenteral nutrition (PN) dependence. Teduglutide, a GLP-2 analogue proven to reduce PN requirements in short bowel syndrome, carries theoretical oncogenic and proliferative risks that have limited its use post-transplant. A 53-year-old male underwent MVT for cirrhosis secondary to diffuse portomesenteric thrombosis. His course was complicated by severe graft rejection and PTLD, necessitating graft colectomy and end ileostomy, with subsequent severe intestinal failure and malnutrition (weight 40 kg, 45% weight loss). Teduglutide facilitated PN independence within four months, sustained weight gain, and restoration of gastrointestinal continuity, without recurrence of rejection or PTLD. To our knowledge, this is the first reported case of teduglutide use following MVT complicated by graft rejection and PTLD, supporting cautious use in the post-transplant setting.