Three-year experience in clinical intestinal transplantation

Area of Science:

• Gastroenterology and Hepatology
• Transplantation Surgery
• Immunology

Background:

• Intestinal failure necessitates complex management, often leading to life-threatening complications from total parenteral nutrition (TPN).
• Intestinal transplantation (ITx) has emerged as a critical therapeutic option for select patients with end-stage intestinal failure.

Purpose of the Study:

• To evaluate the outcomes of 19 adult patients who underwent intestinal transplantation for various causes of intestinal failure.
• To assess the impact of novel immunosuppressive protocols and advanced mucosal surveillance techniques on patient and graft survival.

Main Methods:

• Retrospective review of 19 adult patients undergoing primary ITx between December 2000 and May 2003.
• Utilized three distinct immunosuppressive induction protocols: daclizumab, alemtuzumab, and antithymocyte globulin.
• Implemented a mucosal surveillance protocol involving zoom video endoscopy and serial biopsies with orthogonal polarization spectral imaging for early rejection detection.

Main Results:

• The primary indications for ITx included chronic intestinal pseudo-obstruction, intestinal infarction, and Gardner syndrome.
• Thirteen out of 19 patients (68.4%) experienced acute cellular rejection (ACR), predominantly treated successfully with steroid boluses.
• Overall 1-year patient survival was 82%, with all surviving patients demonstrating functioning grafts and successful weaning from TPN.

Conclusions:

• Modern immunosuppressive strategies combined with early rejection detection significantly improve ITx success rates.
• Intestinal transplantation is a valuable and effective treatment for patients suffering from intestinal failure and associated TPN complications.
• Prompt management of rejection episodes is crucial for achieving long-term graft survival and patient well-being.