Cristina Dopazo¹, Girish Gupte², Ahmed Taha², Paolo Muiesan², Jane Hartley², Peter Bromley³, James Bennett³, Susan V. Beath², Deirdre A. Kelly², Khalid Sharif², Darius F. Mirza²

¹Department of HPB Surgery and Transplants, Hospital Vall d´Hebron, Barcelona, Spain; ²Liver Unit (including small bowel transplantation), Children´s Hospital, Birmingham, United Kingdom; ³Anaesthetic Department, Children´s Hospital, Birmingham, United Kingdom

Intestinal transplantation (with or without the liver) can have significant haemodynamic and metabolic demands on recipients.

Aim: To analyse the impact of pre-operative status and intra-operative metabolic events on outcome during the first six months post-intestinal transplantation.

Patients and Methods: 51 primary small bowel transplants (12- isolated intestinal transplant (IITx group) and 39- combined liver-intestinal transplant (CLITx group)) were included. Risk factors for early mortality analysed included recipient, donor, operative and post-operative variables.

Results:

Early complications (vascular complications, compartment syndrome, acute rejection) were higher in CLITx. Ten patients (19%, all in CLITx group) died in first six months.

In univariate and multivariate analyses, the factors showing independent predictive value for early mortality in CLITx group were:

1. Recipient data: GI bleeding in preceding 3 months, hospitalisation at time of ITx
2. Donor data: no significant variables
3. Intra-operative data:  blood transfusion >70ml/Kg (OR 14, p0.019) and BE 30 min post-reperfusion <-16 (OR 14, p0.001)
4. Post-transplant data: thrombocytopenia day 1-15 (OR 6, p0.024) and vascular complications (OR 7, p0.005)

Conclusion: CLITX patients with metabolic acidosis and persistently low platelet count (<50,000/dL) should be monitored closely in the first 6 months.