Study & Type | Sample size Patient characteristics. | Type of Tx & Protocol | Patient Survival | Graft Survival/weaned from TPN/Hospital stay | Adverse events/complications |
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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%. |