Outcome after intestinal transplantation - Results from one center's 9-year experience

Citation
Dg. Farmer et al., Outcome after intestinal transplantation - Results from one center's 9-year experience, ARCH SURG, 136(9), 2001, pp. 1027-1031
Citations number
31
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ARCHIVES OF SURGERY
ISSN journal
00040010 → ACNP
Volume
136
Issue
9
Year of publication
2001
Pages
1027 - 1031
Database
ISI
SICI code
0004-0010(200109)136:9<1027:OAIT-R>2.0.ZU;2-4
Abstract
Hypothesis: Outcomes after intestinal transplantation have improved during the past decade with refinements in surgical techniques as well as advances in immunosuppression and antimicrobial therapy. Design: Retrospective analysis. Setting: Tertiary care medical center, August 1991 through December 2000. Patients: Adult (5) and pediatric (12) patients with intestinal failure. Al l developed complications from longterm total parenteral nutrition therapy. Median age was 8.6 years and median weight, was 22 kg. Interventions: Primary intestinal transplantation with (n=14) or without (n =3) the liver. Main Outcome Measures: Patient and graft survival, viral infections, reject ion, and nutritional autonomy. Results: Twenty-one intestinal grafts were transplanted into the 17 recipie nts. All donors were cadaveric and were matched by ABO blood group and size . Patient survival at 1 and 3 years was 63% and 55%, respectively. Death-ce nsored graft survival at I and 3 years was 73% and 55%, respectively. There were 1.5 acute cellular rejection episodes per graft and 3 grafts were los t to rejection. Incidences of infection with the Epstein-Barr virus and cyt omegalovirus were negligible with aggressive prophylaxis and preemptive the rapy. Nutritional autonomy was achieved in 69% of grafts surviving more tha n 30 days after intestinal transplantation. Conclusions: Intestinal transplantation is now the standard of therapy for patients with intestinal failure and complications resulting from total par enteral nutrition. Outcomes have markedly improved since initiation of the program. Aggressive immunosuppression as well as prophylaxis and preemptive antiviral therapy have led to low incidences of acute cellular rejection, Epstein-Barr virus, and cytomegalovirus. Finally, nutritional autonomy can be achieved after successful intestinal transplantation.