Is serum gentamicin level a good predictor of graft injury in intestinal transplantation?

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.