Post Transplant Complications

Intestinal transplantation is a complex procedure that can lead to several technical and non-technical complications. Technical complications include anastomotic leaks and vascular thrombosis,  Postoperative sepsis can be avoided by appropriate antibiotic prophylaxis. Because of the high doses of immunosuppressive medications, intestinal transplant recipients are at higher risk of infection compared to other transplant recipients.

Intestinal rejection can be acute cellular, occurring within 90 days following transplantation or acute humoral or antibody mediated rejection. These are treated with steroids, tacrolimus or antilymphocyte antibody induction.

Chronic rejection occurs over a period of time and is diagnosed when there is chronic intestinal failure and biopsy confirms loss of villia and onset of fibrosis and vasculopathy. Some of these patients may require allograft enterectomy and retransplantation.

Post transplant lymphoproliferative disorder is a consequence of immunosuppressive therapy. In general it is EBV related and can  be treated promptly if diagnosed early.

Graft Versus Host Disease is not uncommon in intestinal transplant patients since intestines carry a large lymphatic system overload. Appropriate management includes optimization of immunosuppressive therapy.

Some centers have following a stepwise immunosuppression weaning policy following intestinal transplantation. In Pittsburgh series, 50% of patients were weaned to single dose schedule of tacrolimus twice a week. Attempts are being made to institute protocolized, biopsy guided weaning in patients in some centres.