Recovery from liver dysfunction after adult isolated intestinal transplantation without liver grafting.
OBJECTIVE
We sought to evaluate liver function recovery after isolated intestinal transplantation in adults with irreversible intestinal failure.


METHODS
Over a 5-year period, we transplanted 34 adult patients, 25 of whom received an isolated intestinal graft, 4 a multivisceral graft without a liver, and 5, a multivisceral graft with a liver. Among the group of patients transplanted with the isolated graft we selected 14 recipients with pretransplant liver dysfunction, namely, a serum bilirubin >2 mg/dL (normal value: 1.2) and/or transaminases >100 IU/mL (NV, 37/40). Other inclusion criteria were total parenteral nutrition, period > 3 months, no diagnosis of portal hypertension or cirrhosis. Two patients had biopsy-proven liver fibrosis.


RESULTS
At discharge, all patients recovered liver function to normal values: mean bilirubin blood level was 0.9 +/- 0.96 mg/dL (range: 0.3-1.6) and mean transaminases were 26 +/- 9 and 31 +/- 18 IU/mL (range: 10-44/27-65). After a mean follow-up of 2 years, only one patient has an elevated alanine aminotransferase level without clinical signs of liver disease. Type of pretransplant liver disease did not impact on survival rates.


CONCLUSIONS
In selected cases, an isolated intestinal or a multivisceral graft without a liver can represent a "liver salvage therapy" for an early failing liver in patients with irreversible intestinal failure. Pretransplant liver disease is not a negative prognostic factor.
Lauro
A
A
UO Chirurgia dei Trapianti di Fegato e Multiorgano, Bologna, Italy. augustola@yahoo.com
Zanfi
C
C
Ercolani
G
G
Dazzi
A
A
Golfieri
L
L
Amaduzzi
A
A
Grazi
G L
GL
Vivarelli
M
M
Cescon
M
M
Varotti
G
G
Del Gaudio
M
M
Ravaioli
M
M
Pironi
L
L
Pinna
A D
AD
D000328:Adult; D001663:Bilirubin / Q000097:blood; D003106:Colon / Q000637:transplantation; D006801:Humans; D007410:Intestinal Diseases / Q000145:classification / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D008111:Liver Function Tests; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D014781:Viscera / Q000637:transplantation
D001663:Bilirubin