Five Hundred Intestinal and Multivisceral Transplantations at a Single Center
Top Cited Papers
- 1 October 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 250 (4), 567-581
- https://doi.org/10.1097/sla.0b013e3181b67725
Abstract
Objective: To assess the evolution of visceral transplantation in the milieu of surgical technical modifications, new immunosuppressive protocols, and other management strategies. Summary Background Data: With the clinical feasibility of intestinal and multivisceral transplantation in 1990, multifaceted innovative tactics were required to improve outcome and increase procedural practicality. Methods: Divided into 3 eras, 453 patients received 500 visceral transplants. The primary used immunosuppression was tacrolimus-steroid-only during Era I (5/90–5/94), adjunct induction with multiple drug therapy during Era II (1/95–6/01), and recipient pretreatment with tacrolimus monotherapy during Era III (7/01–11/08). During Era II/III, donor bone marrow was given (n = 79), intestine was ex vivo irradiated (n = 44), and Epstein-Barr-Virus (EBV)/cytomegalovirus (CMV) loads were monitored. Results: Actuarial patient survival was 85% at 1-year, 61% at 5-years, 42% at 10-years, and 35% at 15-years with respective graft survival of 80%, 50%, 33%, and 29%. With a 10% retransplantation rate, second/third graft survival was 69% at 1-year and 47% at 5-years. The best outcome was with intestine-liver allografts. Era III rabbit antithymocyte globulin or alemtuzumab pretreatment-based strategy was associated with significant (P < 0.0001) improvement in outcome with 1- and 5-year patient survival of 92% and 70%. Conclusion: Survival has greatly improved over time as management strategies evolved. The current results clearly justify elevating the procedure level to that of other abdominal organs with the privilege to permanently reside in a respected place in the surgical armamentarium. Meanwhile, innovative tactics are still required to conquer long-term hazards of chronic rejection of liver-free allografts and infection of multivisceral recipients.Keywords
This publication has 40 references indexed in Scilit:
- Evolution of the immunosuppressive strategies for the intestinal and multivisceral recipients with special reference to allograft immunity and achievement of partial toleranceTransplant International, 2008
- NOD2-expressing bone marrow-derived cells appear to regulate epithelial innate immunity of the transplanted human small intestineGut, 2008
- Preservation of the Native Spleen, Duodenum, and Pancreas in Patients With Multivisceral Transplantation: Nomenclature, Dispute of Origin, and Proof of PremiseTransplantation, 2007
- Transplantation tolerance from a historical perspective.Nature Reviews Immunology, 2001
- Clinical Intestinal Transplantation: A Decade of Experience at a Single CenterAnnals of Surgery, 2001
- Outcome Analysis of 71 Clinical Intestinal TransplantationsAnnals of Surgery, 1995
- Cell migration and chimerism after whole-organ transplantation: The basis of graft acceptanceHepatology, 1993
- Logistics and Technique for Combined Hepatic-Intestinal RetrievalAnnals of Surgery, 1992
- FK 506 FOR LIVER, KIDNEY, AND PANCREAS TRANSPLANTATIONThe Lancet, 1989
- SMALL BOWEL TRANSPLANTATIONTransplantation, 1984