2013 - ISBTS 2013 Symposium


Oral Communications - Best Abstracts 1

5.203 - Unique technical and patient characteristics of retransplantation: A detailed single-center analysis of intestinal transplantation.

Presenter: Douglas , Farmer, , United States
Authors: Robert S. Venick1,2, Laura J. Wozniak2, Khiet Ngo4, Jorge Vargas2, Elizabeth A. Marcus2, Susan Ponthieux1, Villy Hwang1, Vatche G. Agopian1, Ali Zarrinpar1, Sue V. McDiarmid1,2, Ronald W. Busuttil1, Douglas G. Farmer1


Unique technical and patient characteristics of retransplantation: A detailed single-center analysis of intestinal transplantation.

Robert S. Venick1,2, Laura J. Wozniak2, Khiet Ngo4, Jorge Vargas2, Elizabeth A. Marcus2, Susan Ponthieux1, Villy Hwang1, Vatche G. Agopian1, Ali Zarrinpar1, Sue V. McDiarmid1,2, Ronald W. Busuttil1, Douglas G. Farmer1

1Surgery/Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; 2Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; 4Pediatric Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, United States

Introduction: Intestinal retransplantation (Re-ITx) is a challenging endeavor traditionally resulting in poor outcomes. There are very few published reports focusing on Re-ITx. This study aimed to: 1) Describe in detail a single center Re-ITx experience, 2) Identify distinct characteristics of the initial/primary (1º-Tx) vs. Re-ITx, 3) Highlight unique predictors of survival for patients undergoing Re-ITx. MethodsAn IRB-approved retrospective analysis of all Re-ITx recipients at a single-center between 1991-2012 was performed. Clinical characteristics of 1º-Tx and Re-ITx were compared using chi-square and t-tests. Survival was computed using Kaplan-Meier methods.  Over 30 variables were analyzed using log-rank test with significance set at P≤0.20.

Results: 23 patients underwent Re-ITx.  Patients were mostly male (83%), Latino (65%), children (74%) (Table 1).{figure1} 1º-Tx was: isolated ITx (8, I-ITx), Liver-ITx (9, L-ITx), multivisceral (1, MVT), modified MVT (2, mMVT), isolated liver transplantation (3, LTx).  The most common cause for 1º-Tx loss was rejection (57%). Mean time from 1º-Tx to Re-ITx was 1.7 ± 1.7 years.  

Significant differences (p≤0.05) between 1º-Tx vs. Re-ITx at the time of transplant included: intubation status, cGFR and type of transplant; variables approaching statistical significance (p≤0.20) were: pre-ITx location, intra-operative blood loss, and requirement for accessory renal transplant.  Median followup time after Re-ITx was 36 mo. Overall 1/3/5 year patient survival following re-ITx was 68/61/50%.  The most common cause of graft loss after Re-Tx was patient death. 4 Re-ITx developed PTLD.

Predictors of patient/graft survival following Re-ITx were:

GRAFT- PRA < 20% (p=0.05),1º-Tx LOS <80 days (p=0.08), no B or T-cell X-match (p=0.15), pediatric age (p=0.16), Tube feeds started < 7 days (p=0.17);

PATIENT- 1º-Tx LOS <80 days (p=0.007), Re-ITx after 2001 (p=0.03), WIT < 1hr (p=0.03), donor spleen transplanted and removed (p=0.12), weight < 20 kg (p=0.19). 

Conclusions: This study analyzes one of the largest experiences with Re-ITx. Re-ITx is a significant undertaking but successful outcomes can be achieved as demonstrated herein. In general, our Re-ITx patients are sicker requiring more specialized hospital care and more careful patient selection. Special focus must be paid to kidney function at time of Re-ITx. Surprisingly, technical factors were not the major cause of failure; instead infection predominated.

 


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