gms | German Medical Science

Introduction: Intestinal transplantation (ITX) is the only causal therapy for patients with irreversible chronic intestinal failure with severe complications under parenteral nutrition (PN). A single center experience of intestinal and multivisceral transplantation over a course of 14 years is presented.

Material and methods: 37 patients (f:m=13:24; mean age 37.9 ± 10.1 years) received isolated intestinal grafts (n=21) and multivisceral transplantations (n=16). Right hemicolon (n=12) and kidney grafts (n=4) were included whenever indicated. Data were collected prospectively. Induction immunosuppression consisted of simulect (n=10) or campath (n=5 ) in era I, as well as thymo and infliximab (n= 22) in era II. n=14 MVTx were performed in era II. Post-tx monitoring included frequent protocol biopsies, screening for HLA and non-HLA antibodies, and immune monitoring.

Results: All recipients presented with intestinal failure due to short bowel syndrome (n=31) or motility disorder (n=6). Median bowel length of patients with SBS was 31.5 ± 19.9 cm for ITX-recipients and 25.7 ± 18.1 cm for MVTX-recipients. Time on waitlist increased from 218.8 ± 171.5 days in era I to 432.6 ± 226.1 in era II, time on PN was 31.7 ± 30.9 days (era I) vs. 58.2 ± 72.7 days (era II), respectively, both resulting in higher recipient morbidity in era II. 1- and 5-year survival rates in era I were 60 % each, however, have increased to 89.5% and 78,9 % in era II. Waitlist mortality was 27.6% for MVTX and 0% for ITX.

Conclusion: An intestinal rehabilitation and transplant programme has been established successfully at our center. The evolution of immunosuppressive strategies as well as of peri- and posttransplant care has resulted in markedly improved outcome despite higher recipient morbidity. Survival rates after ITX and MVTX at our center resemble that of other solid organ transplantations.