2017 - CIRTA


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5- Outcomes after Intestinal Transplantation

16.2 - Predictors and Trends Following Intestinal Transplantation: A single-center’s twenty-five year outcomes

Presenter: Robert, Venick, Los Angeles, United States
Authors: Robert Venick, Elaine Cheng, Vilayphone Hwang, Elizabeth Marcus, Hasan Yersiz, Jorge Vargas, Sue McDiarmid, Ronald Busuttil, Douglas Farmer

Predictors and Trends Following Intestinal Transplantation: A single-center’s twenty-five year outcomes

Robert Venick1,2, Elaine Cheng2, Vilayphone Hwang2, Elizabeth Marcus1, Hasan Yersiz2, Jorge Vargas1, Sue McDiarmid1,2, Ronald Busuttil2, Douglas Farmer2.

1Pediatrics, DGSOM UCLA, Los Angeles, CA, United States; 2Surgery, DGSOM UCLA, Los Angeles, CA, United States

Introduction: Intestinal transplantation (ITx) outcomes have improved significantly over the past twenty-five years, yet the field remains challenged by relatively high rates of infection and rejection, and guarded long-term survival outcomes. The specific aims of this study were to review a large, single center twenty-five year experience and identify variables which have influenced outcomes.

Methods: All recipients of ITx from 1991-2016 were included from an IRB approved prospective database. Over forty demographic, laboratory and technical pre and peri-ITx variables were included. Standard statistical analyses were performed including t-test for variable comparison, Kaplan Meier for survival and Log Rank test for univariate analysis.

Results: 146 ITx were performed in 124 recipients. The majority were male (59%), Latino (53%), children (67%) with surgical short bowel etiologies (79%). The types of transplants included isolated intestine (22%), liver-intestine (52%), multivisceral (MVT, 20%), and modified MVT (m-MVT, 6%). At ITx, 45% were hospitalized and the mean calculated MELD/PELD score was 15±12. Mean total ischemia time was 7.5±1.9hrs. IL2RA was the most common induction immunosuppression (58%) followed by ATG (29%). Mean time intubated was: 8±12 days, initial ICU stay: 23±22 days, and initial LOS 78±40 days.  Mean patient follow-up time was 76±63 months.  Major complications included acute rejection (59%), PTLD (16%), CMV tissue-invasive disease (7%), and GVHD (3%). 5-YR overall patient and graft survival was 66% and 55%. The most common causes of patient death and graft loss were infection and rejection.
Statistically (p <= 0.05) better graft survival was noted with: children <20kg, liver-inclusive grafts, PRA <20%, absence of DSA, negative T-cell crossmatch, WIT <60 Min, temporary transplantation of donor spleen. Strong predictors of improved patient survival were low MELD/PELD at transplant, CrCl >90, CIT <10 hr, WIT <60 min, temporary transplantation of donor spleen, IL2RA induction immunosuppression.

Conclusions: This large, single-center experience confirms that a number of challenges including rejection, DSAs, infection and PTLD remain for ITx recipients.  Analysis reveals several factors which predict poor outcomes, some of which can be manipulated in an effort to further improve survival after ITx.


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