TY - JOUR
T1 - Results of Intestinal and Multivisceral Transplantation in Adult Patients
T2 - Italian Experience
AU - Lauro, A.
AU - Dazzi, A.
AU - Ercolani, G.
AU - Cescon, M.
AU - D'Errico, A.
AU - Di Simone, M.
AU - Grazi, G. L.
AU - Vivarelli, M.
AU - Varotti, G.
AU - De Ruvo, N.
AU - Masetti, M.
AU - Cautero, N.
AU - Di Benedetto, F.
AU - Siniscalchi, A.
AU - Begliomini, B.
AU - Lazzarotto, T.
AU - Faenza, S.
AU - Pironi, L.
AU - Pinna, A. D.
PY - 2006/7
Y1 - 2006/7
N2 - Purpose: We report our experience with intestinal and multivisceral transplantation in Italy. Methods: We performed 23 adult isolated intestinal transplants and seven multivisceral ones, three with liver, between December 2000 and June 2005. Indications for transplantation were loss of venous access (n = 14), recurrent sepsis (n = 10), and electrolyte-fluid imbalance (n = 6), 14 of whom also presented with total parenteral nutrition (TPN)-related liver dysfunction. Immunosuppression was based on induction agents like daclizumab (followed by tacrolimus and steroids) in the first period; alemtuzumab or thymoglobulin (with tacrolimus) in a second period after 2002. Results: The mean follow-up was 742 ± 550 days. Three-year patient actuarial survival rate was 88% for intestinal transplants and 42% for multivisceral (P = .015). Three-year graft actuarial survival rate was 73% for intestinal patients and 42.8% for multivisceral (P = .1). Graft loss was mainly due to rejection (57%). Complications were mainly represented by bacterial infections (92% of patients), relaparotomies (82%), and rejections (72%). Full bowel function without any parenteral nutrition or intravenous fluid support was achieved in 60% of recipients with functioning bowel including 95% on a regular diet. One patient underwent abdominal wall transplantation as well. Discussion and conclusion: Intestinal transplantation has achieved high rates of patient and graft survival with even longer follow-up. Early referral of patients, especially in cases of TPN-liver disease, is mandatory to obtain good outcomes and avoid high mortality rates on the transplant waiting list. Immunosuppressive management remains the key factor to increase the success rate.
AB - Purpose: We report our experience with intestinal and multivisceral transplantation in Italy. Methods: We performed 23 adult isolated intestinal transplants and seven multivisceral ones, three with liver, between December 2000 and June 2005. Indications for transplantation were loss of venous access (n = 14), recurrent sepsis (n = 10), and electrolyte-fluid imbalance (n = 6), 14 of whom also presented with total parenteral nutrition (TPN)-related liver dysfunction. Immunosuppression was based on induction agents like daclizumab (followed by tacrolimus and steroids) in the first period; alemtuzumab or thymoglobulin (with tacrolimus) in a second period after 2002. Results: The mean follow-up was 742 ± 550 days. Three-year patient actuarial survival rate was 88% for intestinal transplants and 42% for multivisceral (P = .015). Three-year graft actuarial survival rate was 73% for intestinal patients and 42.8% for multivisceral (P = .1). Graft loss was mainly due to rejection (57%). Complications were mainly represented by bacterial infections (92% of patients), relaparotomies (82%), and rejections (72%). Full bowel function without any parenteral nutrition or intravenous fluid support was achieved in 60% of recipients with functioning bowel including 95% on a regular diet. One patient underwent abdominal wall transplantation as well. Discussion and conclusion: Intestinal transplantation has achieved high rates of patient and graft survival with even longer follow-up. Early referral of patients, especially in cases of TPN-liver disease, is mandatory to obtain good outcomes and avoid high mortality rates on the transplant waiting list. Immunosuppressive management remains the key factor to increase the success rate.
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U2 - 10.1016/j.transproceed.2006.05.021
DO - 10.1016/j.transproceed.2006.05.021
M3 - Article
C2 - 16908252
AN - SCOPUS:33746896552
VL - 38
SP - 1696
EP - 1698
JO - Transplantation Proceedings
JF - Transplantation Proceedings
SN - 0041-1345
IS - 6
ER -