2017 - CIRTA


This page contains exclusive content for the member of the following sections: TTS, ITA. Log in to view.

7- Infections and Other Lessons Learned after IntestineTransplantation

32.10 - Two decades of experience with intestinal transplantation in Gothenburg, Sweden

Presenter: Gustaf, Herlenius, Gothenburg, Sweden
Authors: Markus Gäbel, Jonas Varkey, Robert Saalman, Audur Gudjonsdottir, Helena Borg, Ingvar Bosaeus, Mihai Oltean, Gustaf Herlenius

Two decades of experience with intestinal transplantation in Gothenburg, Sweden

Markus Gäbel1, Jonas Varkey2, Robert Saalman3, Audur Gudjonsdottir3, Helena Borg4, Ingvar Bosaeus2, Mihai Oltean1, Gustaf Herlenius1.

1Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden; 2Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden; 3Department of paediatrics, The Queen Silvia´s Children´s Hospital, Gothenburg, Sweden; 4Department of paediatric surgery, The Queen Silvia´s Children´s Hospital, Gothenburg, Sweden

Introduction: The first successful intestinal transplantation in the Nordic countries was performed in 1998. Shortly thereafter, an ongoing effort to establish a multinational Nordic multidisciplinary intestinal failure and transplantation unit serving both adult and pediatric patients was initiated.

Since 2003, all Swedish and Norwegian patients are transplanted and followed-up in Gothenburg.

Aim: To summarize two decades of single center experience with intestinal transplantation (ITx) in a Nordic setting.

Results: Patients and intestinal allografts: In total 30 patients (7 children, 23 adults) have received 31 intestinal allografts from deceased donors; (24 full multivisceral (MV) of which; MV & kidney (n=2) and MV+ colon (n=2). Combined liver small bowel (n=1) and 6 isolated small bowel (ISB).

Underlying diagnosis and indications for transplantation: indications were primarily failure of parenteral nutrition (PN) due to liver disease, loss of central venous access & sepsis (n= 23). Non-resectable malignancies: neuroendocrine pancreatic tumors with liver metastases (n=6) and pancreatoblastoma (n=1).

Immunosuppression: 1998-2002 tacrolimus (Tac), steroids and IL-2 receptor antagonist (Daclizumab). 2003-2015: ATG induction and intention to maintain Tac monotherapy. 2016 ->: IL-2 receptor antagonist induction therapy (Basiliximab), Tac, mycophenolate mofetil and steroids.

Acute cellular rejection (ACR) and chronic rejection (CR): ACR was common; adults (65%) and children (70%). Two children have confirmed CR and one required graft enterectomy after 6 years. Two adult patients lost their ISB grafts due to severe exfoliative ACR.

Graft-versus-host disease (GVHD): Five cases (all MV allografts, 4 of these with the spleen included) developed GVHD (skin; n=4 and passenger leukocyte syndrome; n=1). Four of the patients had previous chemotherapy and underlying malignant disorders as indication for transplantation. All resolved.

Post Transplant Lymphoproliferative Disease: in five patients (four children and one adult) during the first year of transplantation. All but one of the adult cases resolved after decreasing immunosuppression.

Patient survival: All (n=31); 83% at 1 year and 63% at 5 years. In the children one-year survival was 100% and 87% at 5 and 10 years. The longest survivor has a 19-year follow-up with excellent graft function. In the NEPT cohort a 50% 5-year survival was seen in spite of advanced disease and universal recurrence.

Conclusion: This Nordic single center experience illustrates the complexities of this treatment modality but also highlights the possibility of long-term survival for life threatening conditions not considered treatable by other means.

Maria T. Bengtsson Med. Sc. Clinical Nutrition, C. Tingaard RN., Sara Eriksson RN..


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.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada