Jonas Varkey¹, Magnus Simrén¹, Gustaf Herlenius²

¹Department of Internal Medicine, The Sahlgrenska University Hospital, Gothenburgh, Sweden; ²Department of Transplantation, Faculty of Surgery, The Sahlgrenska University Hospital, Gothenburgh, Sweden

Introduction: Suggestions regarding a pre-emptive approach have been proposed since the outcome of transplantation has improved. However, the major issue is the long term survival after transplantation in comparison to continued home parenteral nutrition (HPN).

Aim: To investigate the outcome of patients evaluated for intestinal (ITx) or multivisceral transplantation (MvTx).

Methods: All patients referred for ITx or MvTx to the Sahlgrenska University Hospital and HRH Queen Silvia Children´s hospital from February 1998 to March 2010, 43 adults (median age 44(20-67) years; 27F) and 19 children (median age 6(0.5-13) years; 11F) were included.

Patient assessment was done by a multidisciplinary team and criteria for enrolment on the waiting list were based on standardized guidelines.

Results: 19(43%) adults and 11(58%) children were listed for Tx. Of these, 15 adults and 5 children underwent Tx.

A comparison of the 2 and 5 year survival rate was done between different patient groups. In the Tx patients, there was a difference of 78% and 60% whereas the difference in the probable future candidates was 95% and 79%. However among patients awaiting Tx the survival was 40% and in the non-accepted patients 55%.

The 2 year survival rate in the transplanted patients between the time eras 1998-2002 vs 2003-2009 tends to show an improvement of 57% and 85% respectively (p=0.15).

The study of total mortality in the adults shows the following: Transplanted -53%; awaiting Tx -50%; non-accepted patients-29%. In children, 67% of those awaiting Tx and 13% of the non-accepted patients died. All of the transplanted children survived.

The causes of death were as follows: patients awaiting Tx- 100% related to HPN; transplanted patients -63% Tx related factors and non-candidates- 43% due to comorbibities. The deceased children died due to HPN related complications.

Conclusion: Our results confirm the poor prognosis in patients awaiting intestinal transplantation and support the potential lifesaving role of timely transplantation in a selected group of patients.