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Concomitant infusion of unmodified donor bone marrow into unconditioned recipients of intestinal allografts.

Technical improvements and the advent of Tacrolimus, a potent immunosuppressive agent, have made small bowel transplantation (SBTx) a clinical reality. Despite the initial encouraging results, the necessity for protracted use of high doses of immunosuppression (IS) to prevent intestinal allograft rejection was associated with a surge of infectious complications and posttransplant lymphoproliferative disease (PTLD) in these recipients. This prompted us to terminate this clinical trial at the end of 1994 after an accrual of 63 patients1 and to intensify our efforts to ascertain an alternative strategy that would allow more successful SBTx. We have previously established that perioperative infusion of donor bone marrow (BM) to whole organ allograft recipients leads to augmentation of chimerism and an increased incidence of donor-specific hyporeactivity.2 These observations have encouraged us to reactivate the SBTx trial with simultaneous infusion of unmodified donor BM. Reported herein is the clinical outcome of the first seven study and three control patients.