14th International Small Bowel Transplant SymposiumOutcomeUse of Everolimus After Multivisceral Transplantation: A Report of Two Cases
Section snippets
Case Report 1
A 58-year-old white male subject diagnosed with metastatic NET underwent gastrectomy for a primary tumor as well as multiple transarterial chemoembolization procedures for hepatic spread. Due to continued hepatic decompensation, he ultimately underwent MVT. The patient's immediate postoperative course was complicated by an ileocolic anastomotic leak requiring repair and formation of an end-ileostomy. He began treatment with tacrolimus, basiliximab, and prednisone for immunosuppression.
Case Report 2
A 44-year-old African American female patient with a history of metastatic NET underwent a right hemicolectomy for primary tumor followed by multiple transarterial chemoembolization procedures. She underwent MVT with explant demonstrating tumor in the pancreas, liver, and 5 of 14 removed lymph nodes. Her initial regimen included tacrolimus and prednisone for immunosuppression. One month posttransplantation, the patient developed grade 1 acute cellular rejection (ACR) involving the intestine,
Discussion
Our experience in the first case (Table 1) highlights a common concern regarding delays in wound healing with the use of everolimus [10]. This outcome was problematic because the patient required posttransplantation surgical intervention both for his ostomy reversal and the ventral hernia, thus requiring postponement and temporary discontinuation of everolimus. Everolimus has the potential to contribute to hernia formation and may have been the culprit in this case. The second patient (Table 2)
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