Prophylaxis and therapy of early complications for relatives partial live small bowel transplantation / 中华器官移植杂志

ABSTRACT

Objective To investigate prophylaxis and therapy of early complications following relatives' partial live small bowel transplantation.Methods Four relatives' partial live small bowel transplantations were carried out.Among the 4 patients,there were 3 cases of short intestine syn- drome and one case of non-function of small bowel caused by the absence of nerve ganglion of small in- testine.More than 4 antigens of HLA were completely matched between donators and receptors.In- testines of donators were got from terminal ileum with the length of (150?10) cm.After operations, tacrolimus (FK506),mycophenolate mofetil (MMF),and methylprednisolone were used to prevent rejections.Measures such as use of anticoagulation,improving microcirculation and albumin infusion, aimed at regulating the function of blood coagulation and preventing bleeding and formation of thrombus at anastomotic stoma;famotidine and omeprazole were used to prevent irritable ulcer;use of the third generation of cephalosporins antibiotics,ganciclovir and fluconazol could prevent bacteria,vi- rus and eumycete infections;disinfection and care of easily-infected organs were emphasized;receptors were encouraged to get out of their beds to move frequently;glutamine and enteral nutrition were used early to promote recovery of intestinal function.Results Three days after operation,one patient's lung was infected with baumanii,and the infection had been under control after being treated with the third generation cephalosporins antibiotics;five days after operation,haematoma was detected on an- other patient and was cleared through the second operations growth of eumycete was found in 2 pa- tients' excretion and secretion from enteron,and their situations were improved with fluconazol;acute rejections of the 4 patients were detected 20 days after operation and reversed by the increased use of FK506 combined with methylprednisolone.Among the 4 patients,2 of them have survived for a long time,and the first patient has survived for 6 years and 8 months till now and the other one for 3 years and 2 months;furthermore,other 2 patients respectively died of infections 5 months and 35 days after the operations.Conclusion Because of special constitution of intestine,early complications of rela- tives' partial live small intestine transplantation are frequent and complicated.Therefore,prophylaxis and therapy of early complications are crucial to the success of the transplantation.