Intestinal transplantation in Belgium has come of age
Laurens J. Ceulemans1, Arnaud De Roover2, Olivier Detry2, Roberto Troisi2, Xavier Rogiers2, Raymond Reding2, Jan Lerut2, Dirk Ysebaert2, Thiery Chapelle2, Diethard Monbaliu2, Jacques Pirenne2
1Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; 2Belgian Liver Intestine Committee (BLIC), /, Belgium
Introduction:
Intestinal failure requiring Total Parenteral Nutrition (TPN) can be associated with life-threatening complications for which Intestinal Transplantation (ITx) remains the only life-saving option. Since the first ITx has been performed in Belgium in 1999, experience has grown.
Aim:
In a multicenter retrospective review, we analyzed the overall Belgian experience with ITx.
Patients and Methods:
Based on the patient-specific data form of the international ITx registry (ITR) and an additional questionnaire-based survey, all Belgian ITx procedures were reviewed for: overall activity, recipient/donor characteristics, indications, immunosuppression (IS), rejection rate, 1 year (y)/5y patient and graft (death-uncensored) survival (Kaplan-Meier). For the survivors, nutritional (TPN) independence and Quality of Life (QoL) (Karnofsky score) were analyzed.
Results:
All centers participated (100% response rate). 21 ITx were performed in 20 patients (03/99-11/12), distributed among 5 centers: University Hospitals of Leuven(12), Liège(5), Ghent(2), Brussels (Saint-Luc)(1), Antwerp(1). Median (m) recipient age was 38y(8mo-57y). Male/female ratio was 10/10. 5 were pediatrics (<18y) and 15 adults. m donor age was 16y(4mo-56y). ABO blood group was identical in 63%, compatible in 37%. Indications were anatomical or functional short bowel syndrome: intestinal ischemia(5), volvulus(5), Crohn(2), chronic intestinal pseudo-obstruction(2), splanchnic thrombosis(2), Churg-Strauss(1), necrotizing enterocolitis(1), microvillus inclusion(1), intestinal atresia(1) and chronic rejection of a first ITx(1). An isolated small bowel graft was transplanted in 9 patients (plus kidney Tx in 2); 10 received a combined liver and ITx (plus kidney Tx in 2); 2 received a multivisceral Tx. 20 grafts were procured from deceased donors and 1 from a living donor. All patients received tacrolimus-based IS. Basiliximab induction was administered in 14 patients, ATG in 3. In 11 patients donor specific blood was transfused as part of an immunomodulatory protocol. 1y/5y patient and graft survival is 70%/54% and 62%/55%, respectively. 9 patients died due to: sepsis(5), intracerebral hemorrhage(1), trauma(1), NSAID-intake(1), unexplained(1). 1 patient developed postTx lymphoma. Early acute rejection (AR) (<3mo post-Tx) occurred in 6 patients(29%); late AR (>3mo) in 3(17%); 2 chronic rejections (11%) occurred and 1 re-Tx was performed. Out of 11 survivors (m follow-up 1721 days(252d-3873d)), all of them are nutritionally independent (TPN-free) and 10 have a Karnofsky score >90%.
Conclusions:
ITx has come of age in Belgium. During the last 13 years, 21 ITx were performed in 5 centers. 5y patient survival of 54% is achieved, which is comparable to results reported by the ITR. In Belgium, awareness is growing that ITx is a life-saving (and QoL improving) option for selected patients.