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Outcome after intestinal transplantation: results from one center's 9-year experience; discussion 1031-2
D G Farmer1, S V McDiarmid, H Yersiz
1Dumont-UCLA Transplant Center, Room 77-120 CHS, Box 957054, Los Angeles, CA 90095-7054, USA. dgfarmer@mednet.ucla.edu
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. All developed complications from long-term 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, rejection, and nutritional autonomy.
Results:
Twenty-one intestinal grafts were transplanted into the 17 recipients. 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-censored graft survival at 1 and 3 years was 73% and 55%, respectively. There were 1.5 acute cellular rejection episodes per graft and 3 grafts were lost to rejection. Incidences of infection with the Epstein-Barr virus and cytomegalovirus were negligible with aggressive prophylaxis and preemptive therapy. Nutritional autonomy was achieved in 69% of grafts surviving more than 30 days after intestinal transplantation.
Conclusions:
Intestinal transplantation is now the standard of therapy for patients with intestinal failure and complications resulting from total parenteral 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.