2013 - ISBTS 2013 Symposium

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Oral Communications 5

22.323 - TRANSPLANT APPROACH TO THE TREATMENT OF INTESTINAL FAILURE IN ADULTS: ITALIAN SERIES 2000-2012

Presenter: Chiara, Zanfi, , Italy
Authors: Chiara Zanfi¹, Augusto Lauro¹, Giorgio Ercolani¹, Matteo Cescon¹, Matteo Ravaioli¹, Massimo Del Gaudio¹, Alessandro Cucchetti¹, Giacomo Frascaroli¹, Loris Pironi², Antonio Pinna¹

TRANSPLANT APPROACH TO THE TREATMENT OF INTESTINAL FAILURE IN ADULTS: ITALIAN SERIES 2000-2012

Chiara Zanfi¹, Augusto Lauro¹, Giorgio Ercolani¹, Matteo Cescon¹, Matteo Ravaioli¹, Massimo Del Gaudio¹, Alessandro Cucchetti¹, Giacomo Frascaroli¹, Loris Pironi², Antonio Pinna¹

¹Liver and Multiorgan Transplant Unit, St Orsola University Hospital, University of Bologna, Bologna, Italy; ²Center for Chronic Intestinal Failure, St Orsola University Hospital, University of Bologna, Boogna, Italy

Objective: In patients with intestinal failure, three different and interwined options are available: 1) intestinal rehabilitation with medical and surgical reconstructions, 2) long-term total parenteral nutrition, 3) intestinal transplantation. Therapeutic options and timing must be considered for each patient, with the common aim of achieving enteral autonomy.We report our experience of transplant approach to complicated intestinal failure in adult patients.

Methods: Between December 2000 and December 2012 we performed 49 intestinal/multivisceral transplantations in 48 adult patients; underlying diseases were mainly represented by short bowel syndrome, Gardner's syndrome and intestinal pseudo-obstruction. In 3 patients, beacause of the difficult abdominal wall closure, we were performed abdominal wall transplantation. All patients were on TPN support, at various levels, with several life threatening complications of TPN (recurrent septicemia, loss of venous access, impairment of liver function).

Results:After a median follow up of 1776 days (1-4364), 23 patients (48%) are currently alive with 1-3-5 year patient survival rates of 77%, 60% and 55% respectively; the 1-3-5 year graft survival rates were 69%, 55% and 50% respectively. Thirty-five cases underwent induction with Alemtuzumab, 12 with Daclizumab, 2 with Thymoglobulin. Complete nutritional autonomy was achieved in 20 surviving recipients. During the follow up 6 recipients experienced PTLD, treated with Rituximab, antiviral therapy and surgery when possible; 1 case of GVHD, treated with Steroids, Thymoglobulin and fotoapheresis; 4 patients developed chronic rejection, 1 with DSA positivity (she underwent graftectomy and she is waiting retransplantation).

Conclusions:Survival after intestinal transplantation decreases constantly after the procedure. The proportion of patients treated by rescue surgery increased over time, evidence of a more conservative approach to patients with intestinal failure. Intestinal transplantation should not be the first indication, better serving patients who failed a previous non transplant surgical approach or with severe liver failure at time of referral.

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