Intestinal Transplantation for Short Bowel Syndrome from Gun Shot Wounds: A Case Series

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Short bowel syndrome (SBS) is a malabsorption disorder leading to nutritional deficiencies and high morbidity. Gunshot wounds (GSWs) and other abdominal traumas are known causes of SBS. Intestinal transplantation offers a unique therapeutic option for this patient population; however, outcomes are not well elucidated. We present two cases of patients who developed SBS secondary to GSWs, underwent intestinal transplantation, and subsequently required transplant enterectomy. Methods: We evaluated patients with SBS due to GSW receiving an intestinal transplant at a single center for outcomes including rejection, infection, graft survival, and patient survival. Results: Two males sustained GSWs necessitating small bowel and colon resection, leading to SBS that became dependent on parenteral nutrition with multiple line-related complications. Both patients underwent isolated small bowel transplantation. Patient 1: A 21-year-old underwent transplant with post operative course remaining largely unremarkable for 102 months until he presented with abdominal pain and found to be in cellular and humoral rejection. He developed septic shock due to bacteremia and adenovirus enteritis and did not respond to medical management, necessitating eventual transplant enterectomy. Afterwards, he was managed with parenteral nutrition, however clinical course was complicated by multiple infections and opioid misuse. Patient ultimately expired 12 months post-transplant enterectomy. Patient 2: A 37-year-old underwent transplant and remained hospitalized for 41 days afterwards. Three weeks post-transplant he was noted to have cellular and humoral rejection requiring plasmapheresis and immunoglobulin. Approximately 12 months post-transplant, he presented with septic shock and multiorgan failure. Endoscopy revealed ulcerated and friable mucosa, leading to transplant enterectomy. Despite surgical intervention, his clinical status deteriorated, and he expired shortly thereafter. Conclusions: Patients undergoing intestinal transplantation for SBS secondary to GSW represent a unique and understudied population. These cases highlight the significant risks of rejection, transplant enterectomy, and morbidity. Despite these risks, outcomes are robust as illustrated with the first patient who had many years of normal bowel function, post-transplant. Further research is warranted to optimize management strategies and improve survival rates for this vulnerable population as advancements in transplantation continue. CITATION INFORMATION: Nabaty R., Muszkat Y., Nagai S., Beltran N., Pietrowsky T., Jafri S. Intestinal Transplantation for Short Bowel Syndrome from Gun Shot Wounds: A Case Series AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: R. Nabaty: None.

Volume

25

Issue

8

First Page

S843

Last Page

S844

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