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Updated: Mar 25, 2026
Author Spotlight: Studying the Epithelial Effects of Intestinal Inflammation In Vitro on Established Murine Colonoids
Published on: June 2, 2023
[Clinical intestinal transplantation at the University of Pittsburgh: an update]
1T.E. Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania, USA.
Insights
Intestinal transplantation is feasible, with survival rates improving over time. Pediatric patients show better isolated graft survival than adults, though colon inclusion and CMV-positive donors impact adult outcomes negatively.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Immunology
Context:
- Intestinal transplantation is a complex procedure for end-stage intestinal failure.
- This study analyzes outcomes from a significant cohort of intestinal transplant recipients between 1990 and 1996.
- It examines various graft types, patient demographics, and immunosuppression protocols.
Purpose:
- To evaluate patient and graft survival rates following intestinal transplantation.
- To compare outcomes across different types of intestinal grafts (isolated, combined, multivisceral).
- To identify factors influencing survival, including patient age, graft composition, and donor serology.
Summary:
- 87 patients underwent 92 intestinal transplantations (isolated, combined liver-intestinal, multivisceral).
- One-, three-, and five-year patient survival was 73%, 44%, and 44%, respectively; graft survival was 64%, 36%, and 36%.
- Pediatric patients had better isolated graft survival; colon inclusion and CMV-positive donors negatively affected adult survival.
Impact:
- Intestinal transplantation is a viable option, but requires optimization of immunosuppression and graft dysmotility management.
- Findings highlight the need for tailored approaches based on patient age and specific graft characteristics.
- This research contributes to understanding long-term outcomes and challenges in intestinal transplantation.
Abstract:
From May 1990 until August 1996, 87 patients received 92 intestinal transplantation, including an isolated graft (n = 33), combined liver and intestinal grafts (n = 41), and abdominal multivisceral grafts (n = 13). There were 52 children (mean age 3.3 years) and 35 adult patients (mean age 32.6 years). Of these, 29 patients received the colon as a composite of the intestinal graft, and 11 recent patients were given unmodified donor bone marrow cells simultaneously. Postoperative immunosuppression was with Tacrolimus and low-dose steroids, to which either azathioprine, mycophenolate, or cyclophasphamide was added supplementarily. One-, three-, and five-year patient and graft survival was 73% and 64%, 44% and 36%, and 444% and 36%, respectively. There was no statistical difference in patient and graft survival after different types of intestinal transplantation. Although overall patient and graft survival did not differ between pediatric patients and adult recipients, isolated graft survival children was higher than that of adult recipients (57% versus 11% at three years). Transplantation of the grafts from CMV seropositive donors and the inclusion of the colon in the intestinal graft worsened the survival in adult recipients, but not in children. The influence of simultaneous bone marrow transplantation on the outcome is undetermined due to the short follow-up period. Intestinal transplantation has become feasible, but still requires improved immunosuppression and graft dysmotility management to be a clinical practice.
