Is Serum Gentamicin Level a Good Predictor of Graft Injury in Intestinal Transplantation

Abstract Introduction Following intestinal transplant (SBT), the early diagnosis and treatment of rejection is a major management aim. The diagnosis of rejection is based on histology of stomal biopsies. Oral gentamycin (2.5 mg/kg) was used for selective decontamination of the digestive system. Our hypothesis was that gentamycin might be absorbed in the presence of graft dysfunction. Aim Our goal was to assess the correlation between serum gentamycin level and the health of the intestinal graft. Subjects and Methods Among 33 SBT performed from 1993 to 2005, serum gentamycin levels were performed once weekly or more often when there was a suspicion of rejection. All data were analyzed retrospectively. Results Adequate trough levels were achieved for only 23 patients, six of whom had histologically proven rejection and only one did not have a raised gentamycin content. Five patients with raised levels but no rejection included two with severe intestinal ischemia and three with bowel obstruction/ileus. Four of the five patients required laparotomies. Conclusion We concluded that in our study raised serum gentamycin levels were a good predictor of rejection or significant injury to the graft.