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Three years clinical experience with intestinal transplantation
K Abu-Elmagd1, S Todo, A Tzakis
1Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, PA 15213.
Journal of the American College of Surgeons
|October 1, 1994
Summary
Intestinal transplantation shows promise, with multivisceral procedures offering the best long-term survival. Further strategies are needed to improve practicality and patient outcomes in this complex transplant field.
Area of Science:
- Organ transplantation
- Surgical innovation
- Immunosuppression therapy
Background:
- Hepatic transplantation is established, but intestinal and multivisceral transplantation remain challenging.
- Historically, intestinal transplantation attempts yielded poor graft and patient survival.
- The immunosuppressive drug FK 506 has enabled a new era with promising initial results for intestinal and multivisceral transplants.
Purpose of the Study:
- To evaluate the outcomes of intestinal, hepatic and intestinal, and multivisceral allografts.
- To assess the impact of FK 506-based immunosuppression on patient and graft survival.
- To determine the feasibility and practicality of complex organ transplantation.
Main Methods:
- A consecutive series of 43 patients received intestinal, hepatic and intestinal, or multivisceral allografts.
- Immunosuppression was managed using FK 506.
- Grafts included small intestine, with or without colon, and up to four or more organs for multivisceral procedures.
Main Results:
- 30 out of 43 patients survived with functioning grafts after 6-39 months.
- Isolated intestinal transplants had rapid initial recovery but higher long-term rejection rates.
- Multivisceral transplantation demonstrated the highest survival rate (86%) by the end of the study period.
- Most patients resumed oral diet, but intensive post-transplant care was required.
Conclusions:
- Intestinal transplantation has progressed beyond the feasibility stage.
- Strategies to enhance the practicality of intestinal transplantation are necessary.
- Combining intestinal transplantation with autologous bone marrow transplantation is a potential future strategy.