100 multivisceral transplants at a single center.
OBJECTIVE
The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status.


BACKGROUND
Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft.


METHODS
This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date.


RESULTS
The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65% and 63% at 1 year, 49% and 47% at 3 years, and 49% and 47% at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the time of transplant (P = 0.05), and being a child who received Campath-1H induction (P = 0.03). Among 37 patients who had none of these 3 factors (15 adults and 22 children), estimated 1- and 3-year survivals were 89% and 71%, respectively. Patients transplanted since 2001 had significantly less moderate and severe rejections (31.6% vs 67.6%, P = 0.0005) with almost half of these patients never developing rejection.


CONCLUSIONS
Multivisceral transplantation is now an effective treatment of patients with complex abdominal pathology. The incidences of serious acute rejection and patient survival have improved in the most recent experience. Our results show that the multivisceral graft seems to facilitate engraftment of transplanted organs and raises the possibility that there is a degree of immunologic protection afforded by this procedure.
Tzakis
Andreas G
AG
Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Kato
Tomoaki
T
Levi
David M
DM
Defaria
Werviston
W
Selvaggi
Gennaro
G
Weppler
Debbie
D
Nishida
Seigo
S
Moon
Jang
J
Madariaga
Juan R
JR
David
Andre I
AI
Gaynor
Jeffrey J
JJ
Thompson
John
J
Hernandez
Erick
E
Martinez
Enrique
E
Cantwell
G Patricia
GP
Augenstein
Jeffrey S
JS
Gyamfi
Anthony
A
Pretto
Ernesto A
EA
Dowdy
Lorraine
L
Tryphonopoulos
Panagiotis
P
Ruiz
Phillip
P
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery*; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013154:Spleen / Q000637:transplantation*; D013270:Stomach / Q000637:transplantation*; D015996:Survival Rate; D016896:Treatment Outcome
D007166:Immunosuppressive Agents