Background: Allgraftectomy after solid organ transplantation is usually performed as a palliative therapy. After isolated intestinal transplantation (IIT), allograft enterectomy is sometimes necessary as a life-saving procedure, because intestine graft can be an infectious source leading to sepsis or systemic viral infection. This study evaluated indications and outcomes of allograft enterectomy after IIT, as well as assessed the validity as a salvage therapy for retransplantation.

Methods: A total of 51 IIT excluding combined with kidney transplantation between 2003 and 2014 were retrospectively reviewed. Graft and patient survival, reason of graft loss, and history of rejection and cytomegalovirus infection were evaluated. Patients who underwent allograft enterectomy were particularly investigated in terms of the indications, surgical factors, and outcomes, including morbidity, mortality, and status of retransplantation.

Results: One, three and five year graft survival was 76, 53, and 42%. Reason of graft loss included acute rejection in 13, chronic rejection in 5, viral enteritis in 2, sepsis in 4, posttransplant lymphoproliferative disorder in 2, and others in 3. Fifteen received allograft enterectomy, of whom 11 developed sepsis associated with severe rejection, which forced us to proceed with allograft enterectomy. Of these 11 patients, five recovered from sepsis and received retransplantation (median interval = 88 days). Four recovered from sepsis after allograft enterectomy but retransplantation was not performed. Two died from persistent sepsis postoperatively. Refractory cytomegalovirus enteritis led to allograft enterectomy in one, which eventually caused patient death. Three underwent simultaneous allograft enterectomy and retransplantation. Postoperative morbidity included one case each of leak from duodenum stump, acute pancreatitis, arterioenteric fistula, and bleeding from duodenocolic anastomosis.

Conclusion: Allograft enterectomy successfully provided recovery from sepsis in 9 of 11 patients, of whom five were given an opportunity of retransplantation. Perhaps, surgical complications, especially related with bowel anastomosis or stump, need careful investigation postoperatively.

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