2003 report of the intestine transplant registry: a new era has dawned.
BACKGROUND
The intestine has been more difficult to transplant than other solid organs. We analyzed registry data to determine the scope and success of intestine transplantation in the current era.


METHODS
All known intestinal-transplant programs participated. Patient- and graft-survival estimates were obtained using the Kaplan-Meier product limit method and were analyzed with the Wilcoxon statistic.


RESULTS
Sixty-one programs provided data on 989 grafts in 923 patients. Four patients were lost to follow-up. The short-gut syndrome was the most common primary indication for transplantation. Sixty-one percent of the recipients were < or =18 years. Proportionally more combined intestinal and liver transplants were performed in this group. More than 80% of all current survivors had stopped parenteral nutrition and resumed normal daily activities. A multivariate analysis of cases within the last 5 years revealed that transplantation of patients waiting at home, recipient age, antibody induction immune suppression, and center experience with at least 10 cases were associated with improved patient survival. One-year graft survival rates of 81% were achieved in patients who were induced with antithymocyte globulin and maintained on tacrolimus.


CONCLUSIONS
Transplantation is an effective therapy for the treatment of patients with end-stage intestine failure who cannot tolerate parenteral nutrition. With newer immune suppressive protocols, 1-year graft and patient survival rates approach the results of liver transplantation. Further improvement in survival are expected with early referral since suitable donor organs are scarce and survival rates are better when patients are well enough to wait at home for their transplant.
Grant
David
D
University Health Network, Toronto General Hospital, 200 Elizabeth Street, NCSB 11C-1248, Toronto, ON M5G 2C4, Canada. david.grant@uhn.on.ca
Abu-Elmagd
Kareem
K
Reyes
Jorge
J
Tzakis
Andreas
A
Langnas
Alan
A
Fishbein
Thomas
T
Goulet
Olivier
O
Farmer
Douglas
D
D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D015397:Program Evaluation; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014019:Tissue Donors; D016378:Tissue Transplantation / Q000592:standards* / Q000639:trends; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome