Objective(s): Intestinal and multivisceral transplantation has recently evolved and more frequently utilized for patients with irreversible intestinal and TPN failure. End-stage Crohn’s disease (CD) has been the second leading indication in adults. This is the largest worldwide series of CD patients who received visceral transplantation at a single center. Long-term efficacy is addressed with special reference to disease recurrence.

Methods: Over 25 years, 57 CD patients underwent visceral transplantation for a recalcitrant disease with a mean duration of 5+5 years. All patients failed TPN due to multiple line infection (94%), limited venous access (83%) and significant liver damage (80%). Male to female ratio was 1:1.7 with a mean age of 43+10 years. All patients underwent multiple abdominal operations with proctocolectomy in 37 (65%). Simultaneous hepatic replacement was required in 12 (21%) patients with a mean serum bilirubin of 9+11mg/dl. Remaining 45 (79%) received liver-free visceral allografts with intestine alone in 43 and modified multivisceral graft including stomach, duodenum, pancreas, and intestine in 2. Rejection prophylaxis was tacrolimus based with induction therapy in 8 (14%) and recipient pretreatment in 37 (65%) recipients.

Results: With a mean follow-up of 54+48 months, 33 (58%) patients were alive with a retransplantation rate of 7%. Rejection was the leading cause of graft loss with an overall incidence of 56%. Actuarial patient survival was 90% at 1 year, 56% at 5 years, and 43% at 10 years with respective graft survival of 86%, 53%, and 42%. Inclusion of donor liver was associated with better outcome with a 10-year survival rate of 57%. Recipient pretreatment significantly improved patient survival with respective 1, 5, and 10-year survival rates of 92%, 61% and 61%. All survivors achieved full nutritional autonomy. Disease recurrence was histologically documented in 4 (7%) allografts at 3, 15, 18, and 19 months from date of transplant with no impact on graft function. There was no significant (P=0.6) difference in survival between CD and non-CD patients with a higher cumulative risk of rejection induced graft loss among CD patients.

Discussion: Visceral transplantation is an effective life-saving treatment for patients with end-stage CD. Disease recurrence is low with no significant impact on functional survival.