Gabriel Gondolesi¹, Hector Solar¹, Constanza Echeverría¹, Juan Manuel Padín¹, Fabio Nachman², Guillermo Orce³, Adriana Crivelli¹, Maria Inés Martinez¹, Julio Trentadue⁴, Fransisco Klein⁵, Adriana Fernández¹, Carolina Rumbo^1,2

¹Instituto de Trasplante Multiorganico, Unidad de Rehabilitación, Nutrición y Trasplante Intestinal, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina; ²Servicio de Gastroenterología, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina; ³Servicio de Anestesiología, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina; ⁴Servicio de Terapia Intensiva Pediátrica, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina; ⁵Servicio de Terapia Intensiva Adultos, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina

In South America, intestinal failure patients (pts) had the only option of parenteral nutrition (PN) as available treatment for many years because intestinal transplantation (ITx) used to be anecdotal.

Aim: to report the surgical and nutritional outcomes of the largest series of ITx performed at a single center.

Material and Methods: retrospective analysis of all consecutive ITx performed between May 2006 and April 2011. Diagnoses, pre ITx mean time on PN, indication for ITx, time and mortality on the waiting list (WL), type of ITx, mean total ischemia time (TIT), and warm ischemia time (WIT), immunosuppressive regimes, re-operation rate, time for PN discontinuation, nutritional outcome, 3 and 5 year actuarial patient survival are reported.

Results: 29 ITx in 19 children and 10 adults were accomplished; 22 isolated ITx (3 including colon), 7 Multiorgan (MTO) Tx (2 combined, 5 multivisceral - 1 with kidney); 7 received abdominal rectus fascia. Primary diagnoses at evaluation were: volvulus (8), Hirschprung's disease (5), intestinal ischemia (3), gastroschisis (3), others (12);79% presented with short bowel syndrome. The mean time on PN was 32.9 months (range: 8 to 215- months). The main indication for ITx was lack of central venous accesses (12) followed by PN associated liver disease (7), catheter related infectious complications (6) and others (4).The mean time on the WL was 137 days (range: 2 to 477 days); being 179,4 days for children vs 56,4 days in adults (p<0.006). Overall mortality in the WL was 9% (25% for MTO). TIT was 8:13±1:51 hs for pediatric patients and 8:06±2:19 hs for adults (p=NS). WIT for adults and children was 38±11 min and 37±12 min respectively (p=NS). Thymoglobulin-Tacrolimus-Sirolimus-Steroids were used in the MTO and in 3 isolated ITx recipients transplanted with ABO compatible mismatch grafts o high PRA. The other patients received Anti-IL2 ab-Tacrolimus-Mycophenolate-Steroids. The re-operation rate was 55%. Nutritional outcome: children: z- BMI pre Tx -0.57 ± 1.08, z- BMI post Tx -0.45 ±0.87, zH/A pre Tx -2.43 ±1.77, zH/A post Tx -2.53 ±1.31. Adults: pre Tx BMI: 21.1±4.6, current: 21.7±4.9.  Overall 3 and 5 year patient survival is 67% and 60% respectively; and 81% and 71% for Isolated ITx.

Conclusions: After 5 years of establishing a dedicated program, our results proved that ITx is currently an available option in South America.