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.