Augusto Lauro, Chiara Zanfi, Sara Pellegrini, Fausto Catena, Vincenzo Stanghellini, Loris Pironi, Antonio Pinna

S. Orsola Hospital - Liver and Multiorgan Transplant Center, Bologna, Italy

Aim: CIPO has been treated on adult population by TPN or, if complications, by multivisceral transplantation, considering that stomach is often involved.

Subjects and Methods: A retrospective review of 10 adults (11 transplants) with CIPO undergoing intestinal transplantation was performed in our center from 2000 to 2011. The diagnosis of CIPO (symptoms, contrast studies, biopsies) was performed by our team. Complications and outcomes were reviewed.

Results: Nine patients underwent isolated intestinal transplant, 2 multivisceral one (in all cases with feeding tube for enteral nutrition): immunosuppression was represented by FK regimen plus induction with Alemtuzumab in 6 cases, Daclizumab in 4 cases, Thymoglobulin in 1. Average age at transplant was 33.5 years. We reported 1 graftectomy (Thymoglobulin case) followed by successful retransplantation plus abdominal wall transplantation. Six patients are currently alive with working small bowel (2 with TPN support ): causes of deaths were: infections in all 4 remaining cases. Considering the 9 isolated intestinal transplants, 6 received  gastro-jejunostomy (in 3 cases with a duodeno-jejunostomy and a subtotal gastrectomy), in 3 cases we performed a duodeno-jejunostomy only. In all cases but one, we anastomosed the distal graft to the native colon (in 1 case we transplanted the colon).Only in 2 cases we were forced, after transplant, to perform an ileostomy to improve the intestinal motility (those are the cases with TPN support).Graft and patient survival after 5 years are 60% and 70% respectively, and after 10 years 45% and 56%.

Conclusions: Adults with CIPO and irreversible complications of TPN benefit from an isolated intestinal transplant with different types of surgeries to empty the native stomach (gastric resection, gastro-jejunal anastomosis, duodeno-jejunal anastomosis): this strategy achieves good gastric emptying, effective establishment of oral feeding and a graft and patient survival comparable to isolated intestinal transplant for short bowel syndrome