2011 - ISBTS 2011 Symposium

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Oral Communications 16: Long Term Outcomes

21.323 - Eight years of intestinal transplantation in Washington, DC

Presenter: Cal, Matsumoto, Washington, United States
Authors: Cal Matsumoto1, Stuart Kaufman1, Erin Fennelly1, Raffaele Girlanda1, Kirti Shetty1, Cheryl Little1, Clara Torres1, Jaqueline Laurin1, Rohit Satoskar1, Eddie Island1, Jason Hawksworth1, Juan Guerra1, Michael Zasloff1, Thomas Fishbein1

Eight years of intestinal transplantation in Washington, DC

Cal Matsumoto, Stuart Kaufman, Erin Fennelly, Raffaele Girlanda, Kirti Shetty, Cheryl Little, Clara Torres, Jaqueline Laurin, Rohit Satoskar, Eddie Island, Jason Hawksworth, Juan Guerra, Michael Zasloff, Thomas Fishbein

Transplant Institute, Georgetown University Hospital, Washington, DC, United States

The results of intestinal transplantation (ITx) have improved over the last decade. Adult and pediatric ITx was first initiated at Georgetown University Hospital in November 2003. We present our data on iTx over the past eight years of our program. We retrospectively reviewed our experience with ITx. Primary immunosuppression consisted of IL-2 receptor blockade induction with maintenance steroids, Tacrolimus, and Sirolimus. Sensitized recipients or recipients with a positive cytotoxic crossmatch received Thymoglobulin induction. 134 ITx have been performed in 131 patients from November 2003 to May 2011. Mean follow up time was 40 months. Overall average age is 22.6 ± 21.1 years. 66 pediatric (<18 yrs), average age 3.54 ± 4.27 yrs (range 5 months – 17 yrs) and 68 adult, average age 41.02 ± 12.78 yrs (range 18 – 66 yrs). 9 cases of ITx were retransplants ( 3 peds/6 adult), with 6 of the retransplants (3 peds/ 3 adult) having their primary ITx at another center. Grafts comprised of 72 isolated intestines (iITx), 35 liver-intestine (LI), 22 multivisceral (MVTx), and 5 modified multivisceral (mMVTx) transplants. 49 recipients received an en-bloc colon graft and 5 received a concomitant kidney graft. Most common indication in pediatric recipients were Gastroschisis, NEC, and pseudoobstruction. Adult indications were mesenteric ischemia, volvulus, and inflammatory bowel disease. Overall 1 and 3 year patient / graft survival are 81.4% / 80.5% and 67.9% / 67.2% respectively. 1 year iITx, LI, and MVTx patient survival were 84.5%, 88.6%, and 60.1%. 3 year iITx, LI, and MVTx patient survival were 64.1%, 79.6%, and 56.2%. Pediatric 1 year patient survival was 84.1% and adult 1 year patient survival was 77.4%. Overall cellular rejection occurred in 35%. 1 year freedom from rejection (FFR) in adult and pediatric recipients was 63.3% and 81.3% respectively. Liver inclusive grafts had a lower 1 year FFR (p = 0.039). CMV infection incidence was 25.1%, with a more invasive and refractory disease occurring in high risk donor positive to recipient negative serotypes. Overall incidence of PTLD was 8%. This data reflects an eight year cumulative experience of ITx at a single institution with an extensive pediatric and adult ITx experience. Acute cellular rejection and opportunistic infections continue to be vexing clinical issues in ITx.

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