The first small bowel transplant in the UK was undertaken at Addenbrooke’s, Cambridge University Teaching Hospital in 1991. 38 small bowel transplants have since been undertaken in 35 patients. Primary diseases were Crohn’s  (9), Porto-mesenteric vein thrombosis (6)[related to alcohol cirrhosis (2), anti-Thrombin 3 deficiency (1),cystic fibrosis (1), trauma(1) and  Jak 2 mutation(1)], superior mesenteric artery thrombosis (7),  Desmoid tumour(4), Dysmotility(4), Gastrochisis(1), Surgical complication(2), Radiation enteritis (1), volvulus(1). Deaths in the first week, occurred in 4 patients: mediastinal line related bleeding(1), bleeding from portal-hypertension (2) and coagulopathy (1), all at time of surgery. Another patient died in the first month from bleeding and lost  venous access. In addition 4 patients died in  first post-operative year : rejection/sepsis(1), graft ischaemia(1), cancer(1), and CMV disease (1). 6 more deaths after the first year: sepsis(1), rejection sepsis (3), pneumonia(1), and  head injury(1).

All deaths in the first post-operative month  related to severe haemorrhage, in 2 cases to severe portal hypertension (SPH) and  poor venous access in another 2. We have modified practice to reduce the bleeding risk  with SPH. Loss of venous access can be avoided by timely referral. Rejection was implicated in 3/14 deaths all dying of  sepsis. CMV disease resulted in 2 deaths, we endeavour to avoid CMV positive to negative transplants. 3 deaths were in part related to mental illness which led to  loss of graft in 2 others. We have focused on this area also. 3 patients were re-transplanted (2 rejection and 1 infarction) and all remain alive.

Despite these problems our 5 year KM survival figure remains relatively good at 73%  in cohort from 1991, 79% from 2003 and 80% from 2008. Deployment of strategies learned from our experiences should improve our survival outcome over the next era.