Small Intestinal Transplant Rejection

Many factors determine the success of a transplant, including surgical technique, organ preservation, whether infection can be avoided and post-surgical care. However, none is more important than preventing the body from rejecting the transplanted organ. Anti-rejection drugs are used to suppress the immune system. The type and dosage of drugs required to prevent rejection have been key factors in patient survival and severity of transplant rejection symptoms afterwards.

Cyclosporine was a pivotal anti-rejection drug for liver, kidney and heart transplantation. But its use with intestinal transplant patients was less successful.

The intestine is a difficult organ to successfully transplant because patients are exposed to a greater likelihood of complications. The overall historical international survival rate of 45 to 50 percent reflects the challenges that surgeons have faced. One reason for the difficulties is the intestine contains a lot of tissue susceptible to rejection, and a consequence of rejection can be the loss of the surface lining of the intestine, which exposes a patient to infections from bacteria in the stool.

Improvements in survival rates of intestinal transplant in children were seen with the introduction in the late 1980s of another anti-rejection drug, Prograf® (Tacrolimus). Children’s Hospital of Pittsburgh began using Prograf® as the primary immunosuppressant in intestinal transplants in 1990 with moderate success.

Even with Prograf®, intestinal transplant survival beyond the first year or two was much lower than the survival rates seen among heart, kidney and liver transplant patients. As a result, Children’s Hospital explored more ways to resolve the issues that threatened long-term survival.

“We realized that after great one- and two-year survival rates, survival dropped over the course of three years,” says George Mazariegos, MD, director of Pediatric Transplantation at Children’s Hospital of Pittsburgh. “We felt that we needed to step back and analyze our initial experience to see what the causes were and how we could improve it.”

Learn more about Easing the Donor Organ Shortage.