Impact of intestinal transplantation for intestinal failure in Japan

Takehisa Ueno^1,1, Motoshi Wada², Ken Hoshino³, Shinji Uemoto⁴, Tomoaki Taguchi⁵, Hiroyuki Furukawa⁶, Masahiro Fukuzawa⁷

¹Pediatric surgery, Osaka univerity, Suita, Japan; ¹Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; ²Pediatric surgery, Tohoku university, Sendai, Japan; ³Surgery, Keio university, Tokyo, Japan; ⁴HBP / Transpalant surgery, Kyoto university, Kyoto, Japan; ⁵Pediatric surgery, Kyusyu university, Fukuoka, Japan; ⁶Surgery, Asahikawa medical school, Asahikawa, Japan; ⁷Osaka medical center for maternal and child health, Izumi, Japan

Introduction: The prognosis of intestinal failure has improved dramatically in the past few decades with the development of parenteral nutrition (PN). However, PN-dependent patients still have numerous complications. Intestinal transplantation can significantly improve their prognosis and quality of life. We report on impact of intestinal transplantation for intestinal failure in Japan.

Methods: Intestinal transplants have been performed in Japan since 1996. Standardized report forms were sent to all known intestinal transplantation programs, asking for information on intestine transplants performed between 1996 and June 31, 2012. All programs responded. Patient and graft survival estimates were obtained using the Kaplan-Meier method and were analyzed with the Wilcoxon statistic.

Results: Five institutions provided data on 24 grafts in 21 patients. There were 12 cadaveric and 12 living related donor transplants. Causes of intestinal failure included short gut syndrome (n=9), intestinal motility function disorders (n=11), other (n=1), and re-transplantation (n=3). The overall 1- and 5-year patient survival rates were 86% and 68%, respectively. In cases (n=15) after 2006, the 1-year patient survival rate was 92%, and the 5-year survival rate was 83%. Graft 1- and 5-year survival rates were 87% and 78%, respectively. The living related transplant recipient survival rate was 83% at 1 year and 65% at 5 years, whereas patient receiving cadaveric transplants had 1- and 5-year survival rates of 89% and 76%, respectively. Graft survival rates of living and cadaveric donor transplants were 75% and 83% at 1 year, and 56% and 73% at 5 years, respectively. More than 80% of all current survivors discontinued PN.

Conclusion: Intestinal transplant has become an effective therapy for patients with intestine failure who cannot tolerate PN. After 2006, patient and graft survival rates approached rates associated with standard treatment for end-stage intestinal failure.