| dc.description.abstract | Introduction: Intestinal and multivisceral transplantation are considered the biggest
achievements in solid organ transplantation over the last decades. This study analyzes the
technical evolution and options of different transplant modalities, discusses the incorporation of
new surgical techniques, and evaluates the clinical progress of patients who received transplants
with isolated or composite intestinal allografts.
Methods: We conducted a retrospective study of 496 consecutive patients who received 551
intestinal transplants at the University of Pittsburgh Medical Center (UPMC), Pittsburgh,
Pennsylvania, United States of America between May 1990 and May 2010. Allograft modalities
depended on the extension of the disease and the recipient’s clinical characteristics. Of the 551
transplanted allografts, 282 (51%) were isolated intestine and 269 (49%) were composite grafts,
including pancreas-intestine, liver-intestine, multivisceral, or modified multivisceral allografts.
Fifty–four patients received second transplants and one received a third transplant.
Results: Technical modifications uncovered during the study included donor technique, allograft
preparation on back table, techniques dependent on anesthesia advances, and surgical technique.
Surgical techniques evolved in parallel with immunosuppression protocols as they changed
to use more efficient and less toxic drugs. Therefore, the improvement seen in patient and
allograft survival was a result of advances in both surgical technique and immunosuppression
protocols. The follow-up period, varying from six months to 20.7 years, showed that 287
patients (58%) survived. Of the survivors, 202 survived beyond five years, 46 beyond 10 years,
13 beyond 15 years, and two surpassed the 20 year landmark. Over the last 10 years, survival
significantly improved (p<0.001), with one-, five-, and 10-year patient survival rates of 90%,
68%, and 60% respectively, and 86%, 55%, and 48% graft survival rates, respectively. Liver intestine allografts showed better survival compared to isolated intestine allografts. Induction
of immunosuppression and/or pre-conditioning protocol did not alter the risk of graft loss due to
rejection of the liver-free allografts. Patients two- to 18-years-old and those older than 50 at the
time of transplantation had the highest survival rates. Patients receiving multivisceral allografts
showed a significantly higher (p< 0.05) rate of fatal infections compared to patients receiving
other types of allografts. Liver-intestine allograft recipients showed the highest survival rates.
Positive HLA cross-match did not affect graft survival.
Conclusions: The improved survival rates and reduced rates of post-operative complications of
grafts and patients who underwent intestinal or multivisceral transplantation can be attributed to
innovations in surgical techniques during the study period. These innovations were associated
with progress in immunosuppressive strategies and in clinical-anesthetic management. | |
