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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Langnas A et al Intestinal Transplantation at the University of Nebraska:1990-2001. Transpl Proc. 2002;34:958-60. U of Nebraska Oct 1990-Mar 2001 Case series |
N=106 patients 117 grafts. Adults = 13 grafts Pediatrics =104 grafts 7 had previous Tx Mean age: Pediatrics ISB 6 yrs L-SB 2.8 yrs Adult: ISB 35 yrs L-SB 69 yrs Causes ISB: most common Midgut volvulus, pseudo obstruction & massive gut resection L-SB: most common-Midgut volvulus, Gastroschisis & intestinal atresia. |
37 ISB Tx pts (43 grafts0 69 L-SB Tx pts (74 grafts) -New surgical technique to preserve hilum of the liver -11 pts underwent abdominal evisceration & preserve proximal stomach & distal colon. -18 pts used portal vein for venous outflow -15 used the inferior vena cava Post-op management: -Prophylactic antimicrobial agents & alprostadil. -Immunosuppression : cyclosporin in first 5 pts, others received tacrolimus. 11 also got concomitant sirolimus & 26 pts had induction therapy with basiliximab. |
2 year patient survival: -Overall primary pts with tacrolimus=70% -ISB = 82% L-SB = 60% -Longest survival ISB with fully functional allograft = 7 yrs. -Longest surviving L-SB recipient = 10 yrs. -Main cause of death in both groups was sepsis. |
2 yr graft survival for ISB =67% Causes of loss of graft: ISB (18/43) rejection (5), ischemic necrosis (2), chronic rejection (1), arterial thrombosis (1), portal vein thrombosis (1) -3 pts died with functioning graft Average time to discontinuing TPN ISB = 39 days L-SB = 31 days. Median length of stay for the entire group = 64 days (range 5 - 599 days) Median cost of intestinal transplantation $275,000 (range $77,000 - $1,800,000) Conclusion: -Effective life-saving procedure for select patients -Surgical techniques refined & standardized. -Short-term survival satisfactory but long-term still unknown Rejection & sepsis still major obstacle to success. -Cost & LOS still too great |
Rejection Among 61 primary L-SB pts with tacrolimus: 60% had at least 1 episode of rejection with median time to first rejection of 16 days. Among 36 ISB recipients with tacrolimus: 77% had rejection episodes with median time of 12 days. -Antilymphocyte therapy was required to treat rejection in 17/61 L-SB pts & 7/36 ISB pts. -Explantation used to treat rejection in 7/36 ISB pts. -Induction in 24 pts resulted in significant reduction in mean number of rejection episodes & fungal infection. Infection -Bacterial infection in 93% of pts -Fungal infection in 25% of pts. -CMV infection in 16/106 pts (small bowel 10, lung 4). -No graft loss due to CMV. Reoperation in 45% of ISB & 66% of L-SB pts mostly because of intra-abdominal abscess. Post-transplant lymphoproliferative disease: -in 9% of patients median time to diagnosis 4 months -5/10 disease free, functional graft -2/10 required explantation of graft -3/10 died. |