Small Bowel Tx

• 1. Diarrhea/Increased stoma output
• 2. Abdominal pain, distension, and ileus.
• 3. Fever
• 4. Sepsis (due to disruption of the gut mucosal barrier which leads to bacterial and fungal infections)

The majority of the episodes occur during the first 90 days post tx.

• Largest category for graft-loss after the second year.
• Signs include:
• -abdominal pain with diarrhea or bowel obstruction
• -weight-loss
• -failure to thrive.
• The overall incidence of chronic rejection exceeds 10%.
• The median time for the development of CR is 39 months (range of 22-67 months)

Suppresses cellular immunity (inhibits T-lymphocyte activation), by binding to an intracellular protein, FKBP-12 and complexes with calcineurin dependant proteins to inhibit calcineurin phosphatase activity

• Most centers use an induction regimen that includes anti-lymphocyte or anti-IL-2 receptor antibodies, with baseline immunosuppression consisting of a combination of tacrolimus (TAC), +/- corticosteroids.
• Initially, TAC is administered intravenously and switched to oral dosage as soon as the intestine resumes normal function.
• The twelve hour target trough level for TAC is 15 to 20 ng/ml in the first 90 days of the transplant
• The TAC target trough levels is 5 to 10 ng/ml after 90 days

• Cardiovascular:
• -Hypertension (13% to 62%)
• -Edema (peripheral 11% to 36%)
• -Chest pain (19%)
• -Edema (18%)
• -Pericardial effusion (heart transplant 15%)

• Central nervous system:
• -Headache (25% to 64%)
• -Insomnia (30% to 64%)
• -Pain (24% to 63%)
• -Fever (19% to 48%)
• -Dizziness (19%)

• Dermatologic:
• -Pruritus (15% to 36%)
• -Rash (10% to 24%)

• Endocrine:
• -Hypophosphatemia (28% to 49%)
• -Hypomagnesemia (16% to 48%)
• -Hyperglycemia & diabetes (21% to 47%)
• -Hyper/Hypokalemia (8% to 45%)
• -Hyperlipemia (10% to 31%)

• Gastrointestinal:
• -Liver function tests abnormal (6% to 36%)
• -Ascites (7% to 27%)
• -Diarrhea (24% to 72%)
• -Abdominal pain (29% to 59%)
• -Nausea (32% to 46%)
• -Constipation (23% to 36%)
• -Anorexia (7% to 34%)
• -Vomiting (14% to 29%)
• -Dyspepsia (18% to 28%)

Genitourinary: Urinary tract infection (16% to 34%)

• Hematologic:
• -Anemia (5% to 50%)
• -Leukopenia (13% to 48%)
• -Leukocytosis (8% to 32%)
• -Thrombocytopenia (14% to 24%)

• Neuromuscular & skeletal:
• -Tremor (34% to 56%; heart transplant 15%)
• -Weakness (11% to 52%)
• -Paresthesia (17% to 40%)
• -Back pain (17% to 30%)
• -Arthralgia (25%)

• Renal:
• -Abnormal kidney function (36% to 56%)
• -Creatinine increased (23% to 45%)
• -BUN increased (12% to 30%)
• -Oliguria (18% to 19%)

• Respiratory:
• -Atelectasis (5% to 28%)
• -Pleural effusion (30% to 36%)
• -Dyspnea (5% to 29%)
• -Cough increased (18%)

• Infectious Disease:
• -Infection (24% to 45%)
• -CMV infection (32%)