2017 - CIRTA

This page contains exclusive content for the member of the following sections: TTS, ITA

3- Donor Selection and Technical Aspects of Intestine Transplantation

27.4 - Enterostomy after Intestinal transplantation: the first report of complications and outcome.

Presenter: Douglas, Farmer, Los Angeles, United States
Authors: Bernard Dubray, Jr., Wethit Dumronggittigule , Cheng Cheng, Elizabeth Marcus, Robert Venick, Ronald Busuttil, Douglas Farmer

Enterostomy after Intestinal transplantation: the first report of complications and outcome.

Bernard J. Dubray, Jr.1, Wethit Dumronggittigule 1, Cheng Y. Cheng1, Elizabeth A. Marcus2, Robert S. Venick2, Ronald W. Busuttil1, Douglas G. Farmer1.

1Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; 2Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States

Introduction: Temporary enterostomy (OST) formation at the time of intestinal transplantation (ITx) has traditionally been the standard of therapy. The lack of reliable non-invasive monitoring of ITx allograft relegates frequent endoscopy/biopsy via OST as the standard method to diagnose pathology. While complications related to OST formation/takedown procedures are well described in general surgery, the ITx OST has never been reported.

Methods: A retrospective review of a prospectively maintained single-center ITx database from Nov 1991 to August 2016 was performed. Demographic, surgical and outcome variables were recorded. The assessment of OST was divided into two parts – the formation and takedown. OST types were end-ileostomy, loop-ileostomy or blow-hole ileostomy. Criteria for OST takedown included at least 3 months s/p ITx, low dose steroids, stable graft function and no rejection. A standard pre-takedown workup included endoscopy/biopsy and contrast radiography. Overall survival (OS) and graft survival (GS) were assessed. Standard statistics was undertaken.

Results: 123 recipients (age 7.66 yrs (0.62-61.87); weight 23 kg (6.9-96)) received 145 ITx. Allograft types were isolated intestine (23%), liver/intestine (53%), multivisceral (17%), modified multivisceral (7%). OST types at ITx were end (22%), loop (10%), distal blow-hole (56%), proximal blow-hole (8%), and none (4%). 76 OST (54%) underwent takedown.

OST formation: 25 Complications occurred in 24 formations (17%): 10 prolapse (40%), 7 ischemia (28%), 8 other (32%). 12 (50%) were required OST revision. Complications were more likely with liver/intestinal ITx, end type and a history of more reoperations post-ITx. OST takedown rates were significant lower among patients with complication of OST formation (p=0.005). There was no different of GS between patients with and without OST complication (p=0.50).

OST takedown: Median time to takedown: 422 days (18-3928). 16 complications occurred in 13 takedowns (17%): 5 abscess (31%), 5 SBO (31%), 2 hernia (13%), 4 other (25%). With complications, trend toward longer time between ITx and takedown (p=0.07). There were no deaths or graft loss as a result of complication. GS of patients with OST takedown complication was not different from patients without complication (p=0.25).

Conclusions: The first analysis of OST after ITx reveals

1. Most recipients can undergo successful OST formation/takedown

2. Complication rates are surprisingly similar to those seen in general surgery patients despite the higher complexity of ITx patients

3. Complications did not lead to worse outcomes

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.



Staff Directory
This email address is being protected from spambots. You need JavaScript enabled to view it.


The Transplantation Society
International Headquarters
505 Boulevard René-Lévesque Ouest
Suite 1401
Montréal, QC, H2Z 1Y7