Study & Type	Sample size Patient characteristics.	Type of Tx & Protocol	Patient Survival	Graft Survival/weaned from TPN/Hospital stay	Adverse events/complications
Lorman S et al Improved results in small bowel transplantation using sirolimus. Transpl Proc 2002; 34:2002 Mount Sinai Medical Centre, NY. 1998 - Double cohort on sirolimus	With Sirolimus (N = 16) 4 adults (mean age 41.2+/-10 yrs), 12 children (mean age 2.6+/-2.5 yrs). Without sirolimus (N = 21): 9 adults (mean age 39.8+/-11.2 yrs) 9 children (mean age 1.4+/-2.4 yrs)	With sirolimus ISB = 11 L-SB = 9 MV = 1 Without sirolimus ISB 7 L-SB = 8 MV N = 1 Immunosuppression Immediately post-transplant -All received tacrolimus and steroids -First 17 pts used daclizumab -last 17 pts used sirolimus and basiliximab Monitoring Ileal biopsy twice weekly for first 6 weeks, once weekly for next 6 weeks then monthly. Jujenal biopsy if ileal biopsy is negative but suspicion remains high.	Actuarial 1 year survival With sirolimus = 79% Without sirolimus =70% (p=0.78)	Actuarial 1-year graft survival: With sirolimus 80% Without sirolimus 56% (p=0.18) Conclusion Addition of sirolimus to primary immunosuppression regimen resulted in fewer early rejections and less severe rejection episodes with no cases of exfoliative rejection. Results achieved without increased morbidity and trend towards improved 1 yr patient and graft survival. More experience & larger numbers needed.	Rejection First 30 days Without sirolimus: 68% With Sirolimus: 17% (P=0.002) First 90 days Without sirolimus 85% With sirolimus 31% The first rejection more severe in those not receiving sirolimus (p=0.002). Infection Symptomatic viral infection CMV, EBV, adenovirus, difference between 2 groups not significant. With sirolimus 4 deaths Without sirolimus 6 deaths Reoperation First 30 days incidence Without sirolimus 98.5% With sirolimus 60% (p=0.07) Higher tissue healing in sirolimus group but not significant, no impact on the overall reoperation rate.
Beath SCV et al Induction therapy for small bowel transplant Recipients: Early experience in Birmingham, UK. Transpl Proc 2002; 34(5):1892-1893. April 1993 - Dec 2001 Birminghan Children’s Hosp., UK Case series.	N = 21 children -Mean age 30 -Mean wt 11.9 kg -45% hospitalized -Chronic intestinal failure + life-threatening complications secondary to PN. -Indications: Short bowel S (11), Pseudo obstruction (6), mucosal disorders (4)	ISB - 5 pts L-SB 14 pts MV 2 Protocol Oral tacrolimus starting post-op day 1 to achieve 12-hour trough levels of 20-25 ng/mL. All patients also receive hydrocortisone & azathioprine orally for fist 4 weeks. -Maintenance immune suppression comprised tacrolimus (12-hr trough level of 10-15 ng/mL) and prednisione 0.5-1.0 mg/kg per day.	4 (19%) children died of multi-organ failure & respiratory distress syndrome within 6 weeks of transplant. Excluding 3 pts with <12 months follow-up) 1 year survival = 61% (11/18) 2-year survival = 50% (9/18). Cause of late mortality: -Epstein-Barr virus infection & PTLD	Gut function -17/21 survived to be independent of PN -15/21 (71.4%) became independent of PN and recovered to be discharged home at a mean of 8 weeks after transplant. Note This group of pediatric patients appears to have greater tendency towards malignant transformation of EBV primary infection. The maintenance of immune suppression regimen of low-dose prednisolone & tacrolimus alone may have exacerbated the effect of EBV in B lymphocytes because tacrolimus has minimal effect in B cells and will prevent a cytotoxic t-cell response to EBV-infection in B lymphocytes	Small bowel allograft rejection 15 (mild to moderate) CMV disease in 4 of 6 children given CMV positive grafts within 8 weeks (1 graft loss) Intestinal perforation in 4 patients (resulted in death in 1 pt) Neutropenia in 8/17 patients (2-12 weeks post-transplant) - probably drug related. Late complications (8 - 52 wks) Mild rejection (6 patients) Neutropenia (10 pts) Severe gastroenteritis requiring temporary PN (9 pts) Broviac line infection (4 pts) Chronic rejection (4 pts) Intestinal perforation/obstruction (2 pts) EBV viraemia (10 pts) PTLD (6 pts) Conclusion Induction with tacrolimus, azathioprine & hydrocortisone was successful in inducing tolerance & good graft function after small bowel transplantation. Results suggest that maintenance immune suppression of tacrolimus and prednisolone alone should be avoided in EBV, naïve recipients & antiproliferative agents such as mycophenolate or rapamycin be added.