Infection Prophylaxis

Decontamination of bacterial and fungal organisms of the intestinal allograft is attempted before procurement by administering enteric antibiotics to the donor. Mechanical cleansing has turned out to be impractical in deceased donors. Since the graft is certainly not sterile, broad-spectrum antibiotics together with antifungal agents are given to the recipient during transplantation. Because of the powerful immunosuppression, patients are particularly at high risk for developing viral infections. The matching of allografts for cytomegalovirus is difficult to put into routine practice. Patients are given an antiviral agent (usually ganciclovir) prophylactically. Some centers add to this therapy CMV specific hyperimmunoglob-ulin in recipients of CMV positive grafts. Early diagnosis of CMV infection by a variety of means permits pre-emptive treatment of asymptomatic viremia [14].

Lymphoproliferative disorders related to Epstein-Barr virus mediated B-cell proliferation still represent a major problem after intestinal transplantation. In recent years, it occurs less frequently after a general reduction of immunosuppression, but it still occurs more often than after most solid organ transplantations. This complication is more common in the pediatric population with de novo EBV infection. Quantification of the viral load using quantitative polymerase chain reaction allow for the early implementation of therapeutic strategies including changes in the immunosuppression and medication of antiviral therapy. The use of rituximab, a humanized monoclonal antibody, directed against the CD20 molecule expressed on most B-cell lines and most PTLD clones, has led to a significant improvement in outcome [14].

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