Koichiro Uchida, Seigo Nishida, David Levi, Jang Moon, Gennero Selvaggi, Akin Tekin, Taizo Hibi, Leandro Mosna, Ji Fan, Zeki Acun, Antonio Romano, Phillip Ruiz, Andreas Tzakis

Department of Liver and GI Trasnplant Surgery, Miami Transplant Institute / Jackson Memorial Hospital, Miami, FL, United States

Introduction: With introduction of new innovative immunosuppressant strategies and standardized surgical technique, the short-term outcome of intestinal and multivisceral transplantation has improved. However, the status of long term survival after the transplantation is not fully studied.

Patients and Method: The records of 36 patients in adult ( ≧18 yrs) who survived more than 5 years after receiving intestine or multivisceral transplantation at our center were retrospectively reviewed.
Current status, donor factor, recipient factor, rejection, morbidity and mortality were analyzed.

Result: Median follow-up period was 9.2±3.2 years. The mean age of donor and recipient at transplant were 19.8 ± 12.4 and 35.8 ± 11.0 years. Fifteen patients (41.6%) received isolated intestine(ITx), 14(38.8%) multivisceral(MVTx), 5(13.8%) liver and intestine(LI), and 2(5.5%) modified multivisceral transplantation(mMTx). All patients became off TPN after transplant. Thirty-three patients (91.6%) could resume normal activity. Fourteen patients (38.8%) had no rejection within one year after transplantation, and furthermore 10 patients (27.7%) have never experienced any rejection and been doing extremely well. Fifty percents were treated for hypertension. The average creatinine at five years after transplant was 1.97±0.89%. Four patients (11.1%) required regular hemodialysis, and 2 (5.5%) received kidney transplant. There was one (2.7%) diabetes mellitus after transplant. Ten patients (27.7%) were on antidepressant. Three (8.8%) had cancer, and eight (23.5%) had posttransplant lymphoproliferative disorder. Two (2/6, 33.3%) had recurrence of desmoid tumor. Eleven patients died and causes of death were PTLD, cancer, infection, and rejection. Six ITx patients (40%) received a second transplantation after 6.5±4.0 years, indications of retrasplantation were pathological chronic rejection (4/6), and severe acute rejection (2/6). The comparison of patient survival for 5 year survivors between ITx and MVTx showed that MVTx had better long term survival than ITx (p=0.04 Fig1.) Probability of being alive with functional graft in 10 years after transplant for survivors in five year was 71%.

Conclusion: Status of long term survivor after intestine and multivisceral transplantation is good. Especially MVTx recipients have stable outcome.