Chandrashekhar Kubal, Richard Mangus, Joseph Tector, Jonathan Fridell, Rodrigo Vianna

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States

Introduction: Aim of this study was to analyze the indications and clinical outcomes in patients treated with intestinal/ multivisceral transplantation at Indiana University over a period of 8 years.

Methods: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. A diagnosis of rejection, PTLD or GVHD required biopsy confirmation.

Results: Between July 2003 and April 2011, 137 patients received 146 transplants including 91 multivisceral (62%), 18 modified multivisceral (12%), and 37 isolated intestine (26%) transplants with a median follow up of 32 months. There were 33 pediatric patients (23%) and 113 adults (77%). Ages ranged from 3 months to 67 years (median 43 years). Common indications were short gut syndrome with and without liver failure, cirrhosis with portomesenteric thrombosis and slow growing abdominal tumors. Induction immunosuppression included rabbit anti-thymocyte globulin (rATG) and rituximab. Maintenance therapy included prograf and steroids with addition of monthly daclizumab/ basiliximab in patients at increased risk of rejection. With a median follow-up of 32 months, the graft survival is 75%, 64% & 62% at 1 year, 3 years & 5 years respectively, whereas the patient survival is 78%, 68% & 67% at 1 year, 3 years & 5 years respectively. The survival outcomes are comparable between pediatric and adult recipients (log rank; p=0.7) (Figure 1). Overall complications included acute cellular rejection in 23%, GVHD in 7%, and PTLD in 4%. Overall rejection rates in MVT were 13% versus 38% when the liver was not included (p<0.01). Nine patients required re-transplantation, of whom 7 are alive and well. 

Conclusions: The Indiana University program has experienced a rapid growth with increasing volume and improving outcomes over an 8-year period. Improvement has occurred with improved patient selection, surgical technique and surveillance.