Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


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Mini-Oral Communications 1

12.241 - Refining indications for Intestinal retransplantation

Presenter: Francisco, Hernandez, , Spain
Authors: Francisco Hernandez1, Ane M Andres1, Jose L Encinas1, Eva Dominguez1, Manuel Gamez1, Francisco J Murcia1, Nuria Leal1, Leopoldo Martinez1, Manuel Molina2, Esther Ramos2, Jesus Sarria2, Eva Martinez-Ojinaga2, Gerardo Prieto2, Esteban Frauca3, Manuel Lopez-Santamaria1

Refining indications for Intestinal retransplantation

Francisco Hernandez1, Ane M Andres1, Jose L Encinas1, Eva Dominguez1, Manuel Gamez1, Francisco J Murcia1, Nuria Leal1, Leopoldo Martinez1, Manuel Molina2, Esther Ramos2, Jesus Sarria2, Eva Martinez-Ojinaga2, Gerardo Prieto2, Esteban Frauca3, Manuel Lopez-Santamaria1

1Pediatric Surgery, La Paz University Hospital, Madrid, Spain; 2Pediatric Gastroenterology, La Paz University Hospital, Madrid, Spain; 3Pediatric Hepatology, La Paz University Hospital, Madrid, Spain

 

Aim:
Intestinal retransplantation is becoming more frequent as the number of long-term survivors of intestinal transplantation increases. We present our experience in intestinal retransplantation with special interest in the type of graft.
Material and Methods:
Patients who underwent intestinal retransplantation in our institution were included in the study. The impact of the type of primary and subsequent grafts were analyzed Long-term results were compared to the rest of the series.
Results:
A total of 71 patients underwent intestinal transplantation from 1997 to 2012, among them 12 (16%) required retransplantation (2 received 3 grafts). The grafts were lost at a mean of 153 days (range 5 to 769 days). Two out of the 12 children have died (2 are on TPN) All but one of the primary grafts lost were intestine only grafts. Regarding outcome by type of graft: 6 patients with SBTx-SBTx  lost their grafts, one CLSB-CLSB were also lost; and surprisingly, 5 out of the 7 cases of  SBTx-MVTx, the so-called graft upgrading strategy, are alive with functioning grafts. Patients who received a MVTx as the second or third graft showed long-term outcome comparable to our main series of intestinal transplantation (5 year survival, 71 vs 58%) and this results are even better when the cause of retransplantation was rejection (acute, exfoliative or chronic). Median follow-up was 1118 (10 – 3380) days.
Conclusions:
Retransplantation with multivisceral grafts showed excellent long term results, specially when the cause of previous graft failure was rejection; on the other hand, all patients who received isolated SBTx as the second graft suffered graft lost. 


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