2017 - CIRTA
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5- Outcomes after Intestinal Transplantation
16.11 - Predictors of long term survival in visceral transplant recipients: a single center experience
Presenter: Ahmed, Elsabbagh, Wash, United States
Authors: Ahmed Elsabbagh, Jason Hawksworth, Raffaele Girlanda, Alexander Kroemer, Stuart Kaufman, Khalid Khan, Nada Yazigi, Rohit Satoskar, Thomas Fishbein, Cal Matsumoto
Predictors of long term survival in visceral transplant recipients: a single center experience
Ahmed M. Elsabbagh1, Jason Hawksworth1, Raffaele Girlanda1, Alexander Kroemer1, Stuart S. Kaufman1, Khalid M. Khan1, Nada A. Yazigi1, Rohit Satoskar1, Thomas M. Fishbein1, Cal S. Matsumoto1.
1MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, United States
Background: Despite continual improvement in early survival, the long-term outcomes of visceral transplantation remain conservative.
Study Design: Single-center retrospective analysis of all visceral allograft recipients who underwent visceral transplant between November 2003 and December 2013 with at least 3 year follow up data. Clinical data from a prospectively maintained database was used to assess outcomes including patient and graft survival.
Results: Of 174 recipients, 90 (51.7%) were adults and 84 (48.3%) were pediatric patients. Types of visceral transplants were 98 (56.3%) isolated intestinal transplant, 44 (25.3%) combined liver intestinal transplant, and 32 (18.4%) multi-visceral transplant. Median follow up was 8.1 (3- 13.2) years. 3-, 5-, and 10-year overall patient survival was 69.5%, 66%, and 63%, respectively, while 3-, 5-, and 10-year overall graft survival was 67%, 62%, and 61%, respectively.
In univariable analysis, significant predictors of survival included pediatric recipient (odds ratio [OR] = 2.138; 95% CI, 1.251-3.656); P= 0.005), low donor/recipient weight ratio (odds ratio [OR] = 1.224; 95% CI, 1.017-1.473; P= 0.032), no episodes of severe acute rejection (odds ratio [OR] = 1.939; 95% CI, 1.160-3.243; P= 0.012), history of functional bowel problem (odds ratio [OR] = 1.950; 95% CI, 1.142-3.332; P= 0.014), no simultaneous kidney transplantation (odds ratio [OR] = 3.138; 95% CI, 1.250-7.880; P= 0.015) and less HLA-A mismatch (odds ratio [OR] = 1.815; 95% CI, 1.098-3.012; P= 0.02).
In multivariable analysis, significant predictors of survival included pediatric recipient (odds ratio [OR] = 2.249; 95% CI, 1.256-4.027); P= 0.006), low donor/recipient weight ratio (odds ratio [OR] = 1.234; 95% CI, 1.023-1.488; P= 0.028) and no episodes of severe acute rejection (odds ratio [OR] = 2.032; 95% CI, 1.158-3.566; P= 0.013).
Conclusions: Visceral transplantation remains a good option for treatment of end stage intestinal failure with parenteral nutritional complications. Proper graft selection and improvement of immunosuppression regimens could significantly improve the long-term survival.
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