Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

21 May 2009

Five hundred intestinal and multivisceral transplantations at a single center

KM Abu-Elmagd, G. Costa, G. Bond, K. Soltys, R. Sindhi, G. Mazariegos

Ann Transplant 2009; 14(1): 15-16 :: ID: 880250


Background: To assess evolution of intestinal/multivisceral transplantation and therapeutic efficacy of newly developed immunosuppressive and management strategies.
Material/Methods: Over nearly two decades, divided into three eras, 453 patients received 500 visceral transplants; 215 intestine alone, 151 liver-intestine, and 134 multivisceral. Each era was defi ned by the utilized immunosuppressive protocol with tacrolimus-steroids only in era I (n=114), adjunct induction multi-drug therapy in era II (n=87), and recipient pretreatment
with Thymoglobulin/Campath and tacrolimus monotherapy with spaced dosage in era III (n=252). During eras II/III, adjunct donor bone marrow was given in 79(22%), the intestine was irradiated (7.5 Gy) in 44(12%), and Epstein-Barr-viral load was monitored. Results: Actuarial survival for total population was 85% at 1-year, 62% at 5-years, 42% at 10-years, and 35% at 15-years with graft survival of 80%, 50%, 32%, and 29%. With 10% retransplantation rate, second/third graft survival was 75% at 1-year and 57% at 5 and 10-years. There was no significant difference in survival outcome according to age, bone marrow infusion, and allograft irradiation. The liver-contained allografts had best long-term survival and lowest risk (p=0.0001) of graft loss from rejection. Both patient and graft survival has significantly (p=0.000) improved during era III with 1 and 5-year patient survival of 92% and 71%; respectively. Despite pre-transplant lymphoidepletion, era III was associated with significant reduction in morbidity (p=0.0001) and mortality (p=0.001) of post-transplant lymphoproliferative disorders.
Conclusions: The reported herein achieved survival outcomes with minimization of immunosuppression justifies lifting the level of intestinal/multivisceral transplantation to that of other abdominal organs with the potential to permanently reside in a respected place in the surgical armamentarium.

Keywords: Transplantation, Immunosuppression


In Press

06 May 2022 : Original article  

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of D...

Ann Transplant In Press; DOI: 10.12659/AOT.936293  

27 Apr 2022 : Review article  

A Systematic Review of the Literature on Chronic Kidney Disease Following Liver Transplantation

Ann Transplant In Press; DOI: 10.12659/AOT.935170  

Most Viewed Current Articles

31 Dec 1969 : Original article  

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...

DOI :10.12659/AOT.933588

Ann Transplant 2021; 26:e933588

31 Dec 1969 : Review article  

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

DOI :10.12659/AOT.934924

Ann Transplant 2022; 27:e934924

31 Dec 1969 : Review article  

Kidney Transplantation in the Times of COVID-19 – A Literature Review

DOI :10.12659/AOT.925755

Ann Transplant 2020; 25:e925755

31 Dec 1969 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358