Introduction: Hypomagnesaemia is a frequent complication in the early post isolated intestinal transplantation period and particularly associated with the use of calcineurin inhibitor(CNI) which impair renal tubular function causing tubular magnesium loss. Intestinal transplant recipients are at risk of hypomagnesaemia due to the high dosage of immunosuppressant post transplant than other organ transplantation. And we initiated an intestinal transplant program in Taiwan since 2007. We check the magnesium serum level regally after intestinal transplantation and provide magnesium supplement when the level below normal level to prevent hypomagnesaemia.

Methods: Twenty-two isolated intestinal transplantations were operated in 21 patients (6 children and 15 adults) with one re-transplantation. Immunosuppression protocol included tacrolimus with combination of low-dose steroids and MMF in some cases. Infectious complications were monitored over CMV and EBV titers. Scheduled biopsy of the graft and biochemical analysis of blood samples were used for the surveillance on the patient condition and graft function. Magnesium level was monitored weekly to monthly and Mg Sulfate 10- 20mg was provided according to the level. We analyzed the cases with graft above 1-year survival and calculated the percentage of magnesium supplement among these patients.

Results: The causative factors for intestinal failure in these 21 patients include short bowel syndrome (16/21, 80%) and motility disorder (5/21, 24%). Indications for intestinal transplantation were repeated catheter-related sepsis (4/21, 20%), liver function impairment (1/21, 5%), major vein thrombosis (5/21, 25%), and ultra short bowel (11/21, 55%). The survival rates for 1-year, 3-year, and 5-year are 87%, 75%, and 65% for patients. In the 13 grafts that survive longer than 1 year, we found more than 90% patients had hypomagnesium and received supplement with 20meq Mg Sulfate everyday to maintain their Magnesium level around the lower normal limit of 1.6 mg/dl in early period after isolated intestinal transplantation.

Conclusion: Isolated intestinal transplantation is promising and high prevalence of magnesium deficiency was reported in the early post transplant period. Monitor magnesium level and supplementation after intestinal transplantation was essential.