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2011 - ISBTS 2011 Symposium

Oral Communications 6: Surgical Aspects of ITX

8.144 - 100 multivisceral transplants: a single center experience

Presenter: Rodrigo, Vianna, indianapolis, United States
Authors: Chandrashekhar Kubal1, Richard Mangus1, Joseph Tector1, Jonathan Fridell1, Rodrigo Vianna1

100 multivisceral transplants: a single center experience

Chandrashekhar Kubal, Richard Mangus, Joseph Tector, Jonathan Fridell, Rodrigo Vianna

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States

Introduction: A composite stomach, pancreas and small intestine graft with or without the liver is used for multivisceral transplantation (MVT). The aim of this study was to evaluate indication and clinical outcomes of the first 100 MVTs performed at Indiana University.

Methods: A database of intestinal transplant patients was maintained prospectively. Primary endpoints of this study were graft and patient survival. Graft function was monitored by laboratory tests and serial ileoscopies/ colonoscopies with biopsies.

Results: Between August 2003 and October 2010, 92 patients received 100 transplants including 85 multivisceral and 15 modified multivisceral transplants. Nineteen (22%) patients received simultaneous kidney transplants. There were 24 pediatric patients and 76 adults, with a median age of 41 years (range: 0.5 to 66). Indications were: short gut syndrome with liver failure, cirrhosis with complete portomesenteric thrombosis, slow growing abdominal tumors, intestinal pseudo-obstruction and others. Induction immunosuppression therapy included rabbit anti-thymocyte globulin (rATG) & rituximab. Maintenance therapy included prograf and steroids with addition of monthly daclizumab/ basiliximab in patients at increased risk of rejection. At a median follow-up of 36 months, the graft survival is 72%, 59% & 59% at 1 year, 3 years & 5 years respectively, whereas the patient survival is 75%, 64% & 64% at 1 year, 3 years & 5 years respectively. The overall patient survival has increased to 75% for the transplants performed in year 2008 and later (Figure 1). Complications included acute cellular rejection in 20%, GVHD 11%, and PTLD 5%. Rejection rates were significantly higher in the grafts that did not include the liver (50% vs. 14%; p<0.005).

Conclusions: The clinical outcomes following MVT have improved with maturation of the program. Sepsis and GVHD are the major complications leading to death. With immune surveillance and tailoring of the immunosuppression, further improvement in the outcomes may be possible.

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