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. 2003 Apr 1;3(1):1–72.
Study & Type Sample size Patient characteristics. Type of Tx & Protocol Patient Survival Graft Survival/weaned from TPN/Hospital stay Adverse events/complications
Abu-Elmagd et al /Clinical Intestinal
Transplantation: A decade of experience at a single centre, /Annals of Surgery
2001; 234(3) 404

(U of Pittsburgh Med Centre)

Study period = 1990 - Feb. 2001 (1 yr interruption

Case series
N = 155 primary recipients

(71 adults mean age 38+/-11 years; 84 children mean age 4.9+/-4.8 years) -165 allografts

Indications: Short gut
syndrome - 82%
Dysmotility syndrome - 9%
Intestinal neoplasm - 6%
Enterocyte failure 3%
Adults: 54% ISB 46% L/SB or MV Tx
Children: 27% ISB, 73% L-SB or MV Tx Overall: 39% ISB, 46% L-SB, 15%
Immunosuppresant: tacrolimus & steroids, IV Prostaglandin E1, Adjunct Cyclophosphamide or daclizumab (IgG1 antibody) and rapamycin.
-Donor bone marrow augmentation in 39 pts
-11 grafts irradiated

-Most common reason for the composite allografts was liver failure induced by TPN.
Overall actuarial Survival rate:
1 yr - 75%
5 yrs - 54%
10 yrs - 42%
Treated with daclizumab, 1 yr actuarial survial:86%
(P=0.3)
Graft survival 82%
(P=0.2)

L-SB Tx best survival prognosis beyond 5 yrs.

-83 (53.6%) still alive
Total deaths = 72 (47%)
Cause:
Infection: 18%
Rejection: 5%
PTLD: 6%
Technical: 6%
Others: 12%
49% (76)of recipients had functional graft after a mean follow-up of 43+/-40 moths, unrestricted oral diet.
7 (8%) of the surviving recipients returned to TPN

Longest surviving functional graft:
1 L-SB Tx 129 months
1 MV Tx: 114 months

Pt. & graft survival rates improved since 1994, reasons indeterminate.

Mean ICU stay: before 1994: 29+/-44 days, after 1994: 16+/-23 days
Due to improved speed of recovery & allograft absorptive functions. 1995-2001
complete D/C from TPN after a median of 20 days (42 days median before 1995)
Rejection:
First 30 post-op days: 67% - 85%(before daclizumab) Refractory rejection -primary cause of failure of 19% of the 165 grafts (ISB 37%, L-SB 8% and MV 8%)
-Cumulated risk of loss from acute and chronic rejection of ISB allografts significantly greater than that of composite L-SB & MV Txs (P=0.00001) and risk not significantly reduced by use of daclizumab.
-chronic rejection in 11% of grafts.
Graft versus Host Disease
Clinically observed in 8.4% histologically documented in 4.5%. Fatal in 1 L-SB recipient with preexisting IGA deficiency.
PTLD: in 19% pts (before 1994 33%, after 1994 15%), fatality before 1994: 44%, after 1994 8%) 1 yr cumulative risk with adjunct donor bone marrow: 7%, control 20%.