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Published on: August 20, 2007
Ten-Year Experience With Bowel Transplantation at Seoul St. Mary's Hospital
H K Chang1, S Y Kim1, J I Kim1
1Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Insights
This study reviews intestinal transplantation (ITx) outcomes over 10 years, showing a 73.33% one-year survival rate. Despite a small patient cohort, ITx significantly influenced Korean medical policy and reimbursement.
Area of Science:
- Gastroenterology
- Transplantation Surgery
- Immunology
Background:
- Intestinal transplantation (ITx) is a complex procedure for end-stage intestinal failure.
- Seoul St. Mary's Hospital conducted a 10-year retrospective review of its ITx cases.
- Understanding outcomes and challenges is crucial for advancing ITx protocols.
Purpose of the Study:
- To analyze the clinical outcomes and complications of intestinal transplantation.
- To evaluate patient and graft survival rates following ITx.
- To assess the broader socio-economic impact of ITx in Korea.
Main Methods:
- Retrospective review of 15 consecutive intestinal transplantation cases (2004-2014).
- Analysis of patient demographics, primary diseases, surgical procedures, immunosuppression protocols, and rejection episodes.
- Evaluation of early mortality, surgical complications, and long-term survival using Kaplan-Meier analysis.
Main Results:
- A total of 15 patients (5 children, 10 adults) underwent ITx for various conditions including mesenteric vessel thrombosis, Hirschsprung disease, and necrotizing enterocolitis.
- Induction immunosuppression included daclizumab, basiliximab, alemtusumab, or basiliximab with rabbit antithymocyte globulin (rATG); maintenance involved tacrolimus monotherapy.
- Seven cases of acute cellular rejection were treated with rATG, and three antibody-mediated rejections were treated with rituximab-based regimens.
- Early mortality (within 6 months) occurred in 4 cases due to causes like shock, rejection, dysmotility, and sepsis.
- One-year patient and graft survival rate was 73.33%.
Conclusions:
- Intestinal transplantation achieved a 73.33% one-year survival rate in this cohort.
- Despite a small number of cases, ITx has had a significant social impact, driving changes in Korean medical laws and reimbursement policies.
- Further research and larger cohorts are needed to optimize ITx strategies and improve long-term outcomes.
Abstract:
A retrospective review of intestinal transplantation (ITx) at Seoul St. Mary's Hospital was made by collecting clinical data over the past 10 years. Fifteen consecutive cases from 2004 were analyzed. Five children and 10 adults (6 months to 69 years of age) were included. Primary diseases in adults included 4 mesenteric vessel thromboses, 2 strangulations, and 1 each of visceral myopathy, malignant gastrointestinal stromal tumor (GIST), mesenteric lymphangiectasis, and injury. Pediatric cases involved 2 Hirschsprung disease, 2 visceral myopathy, and 1 necrotizing enterocolitis. Three of 7 stomas were closed using a serial transverse enteroplasty procedure before transplantation. The ITx were performed using 3 living-donor Itx, 12 deceased-donor ITx, 14 isolated Itx, and 1 modified multivisceral transplantation. Daclizumab, basiliximab, alemtusumab, or basiliximab with rabbit antithymocyte globulin (rATG) was used for the induction; tacrolimus monotherapy was used as the basic maintenance immunosuppressant; and m-TOR inhibitor was used for renal dysfunction patients. Seven cases of acute cellular rejection were treated with rATG. Three cases of antibody-mediated rejection were treated with rituximab alone or with rituximab and bortezomib combination. There were 4 cases of early mortality within 6 months after Itx. Causes of death were declamping shock, cardiac tamponade with acute cellular rejection, dysmotility, and sepsis. Surgical complications consisted of 1 feeding jejunostomy displacement, and a minor leakage at a colo-colostomy site. One-year survival of the patient and graft was 73.33% (Kaplan-Meier survival curve). Although the total number of ITx is small, its social impact has been remarkable in changing the related laws and reimbursement policy in Korea.
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