Introduction:

Intestinal failure requiring Total Parenteral Nutrition (TPN) can be associated with life-threatening complications for which Intestinal Transplantation (ITx) remains the only life-saving option. Since the first ITx has been performed in Belgium in 1999, experience has grown.

Aim:

In a multicenter retrospective review, we analyzed the overall Belgian experience with ITx.

Patients and Methods:

Based on the patient-specific data form of the international ITx registry (ITR) and an additional questionnaire-based survey, all Belgian ITx procedures were reviewed for: overall activity, recipient/donor characteristics, indications, immunosuppression (IS), rejection rate, 1 year (y)/5y patient and graft (death-uncensored) survival (Kaplan-Meier). For the survivors, nutritional (TPN) independence and Quality of Life (QoL) (Karnofsky score) were analyzed.

Results:

All centers participated (100% response rate). 21 ITx were performed in 20 patients (03/99-11/12), distributed among 5 centers: University Hospitals of Leuven(12), Liège(5), Ghent(2), Brussels (Saint-Luc)(1), Antwerp(1). Median (m) recipient age was 38y(8mo-57y). Male/female ratio was 10/10. 5 were pediatrics (<18y) and 15 adults. m donor age was 16y(4mo-56y). ABO blood group was identical in 63%, compatible in 37%. Indications were anatomical or functional short bowel syndrome: intestinal ischemia(5), volvulus(5), Crohn(2), chronic intestinal pseudo-obstruction(2), splanchnic thrombosis(2), Churg-Strauss(1), necrotizing enterocolitis(1), microvillus inclusion(1), intestinal atresia(1) and chronic rejection of a first ITx(1). An isolated small bowel graft was transplanted in 9 patients (plus kidney Tx in 2); 10 received a combined liver and ITx (plus kidney Tx in 2); 2 received a multivisceral Tx. 20 grafts were procured from deceased donors and 1 from a living donor. All patients received tacrolimus-based IS. Basiliximab induction was administered in 14 patients, ATG in 3. In 11 patients donor specific blood was transfused as part of an immunomodulatory protocol. 1y/5y patient and graft survival is 70%/54% and 62%/55%, respectively. 9 patients died due to: sepsis(5), intracerebral hemorrhage(1), trauma(1), NSAID-intake(1), unexplained(1). 1 patient developed postTx lymphoma. Early acute rejection (AR) (<3mo post-Tx) occurred in 6 patients(29%); late AR (>3mo) in 3(17%); 2 chronic rejections (11%) occurred and 1 re-Tx was performed. Out of 11 survivors (m follow-up 1721 days(252d-3873d)), all of them are nutritionally independent (TPN-free) and 10 have a Karnofsky score >90%.

Conclusions:

ITx has come of age in Belgium. During the last 13 years, 21 ITx were performed in 5 centers. 5y patient survival of 54% is achieved, which is comparable to results reported by the ITR. In Belgium, awareness is growing that ITx is a life-saving (and QoL improving) option for selected patients.