Initiation of an intestinal transplant program: the Indiana experience.
BACKGROUND
Establishment of a new intestinal transplant (Itx) program in the United States entails significant programmatic costs and a steep learning curve. We report results of the first 4 years of the program at Indiana University.


METHODS
Forty-six intestinal and multivisceral transplants (MVtx) were performed between 2003 and 2007. All organ procurements were performed by our team. Immunosuppression included an induction protocol combined with maintenance tacrolimus monotherapy. Scheduled rejection surveillance was with magnification endoscopy.


RESULTS
Forty-three patients (13 children and 30 adults) received 10 Itx (22%), 5 modified MVtxs (11%), and 31 (MVtx, 67%). Recipient ages ranged from 3 months to 66 years, with median follow-up time of 15 months. Thirty-five patients are currently alive (81%). Patient and graft survival at 30 days was 85%/86% in pediatric and 93%/91% in adult; overall survival was 69%/64% in pediatric and 87%/75% in adult. Thirty patients (69%) experienced episodes of rejection. Multivisceral transplanted patients experienced less episodes of severe rejection (2/31, 6%) when compared with patients with isolated Itx and modified MVtxs. Retransplantation was performed in three patients with nonresponsive severe acute rejection.


CONCLUSIONS
The Indiana University Intestinal and Multivisceral Transplant program experienced significant early graft loss and mortality among pediatric patients, but not among adults. This discrepancy resolved within 2 years of program initiation. After 4 years, adult and pediatric graft and patient survival statistics are similar to those at other programs.
Vianna
Rodrigo M
RM
Department of Surgery, Transplant Section, Indiana University School of Medicine, Indianapolis, Indiana 46202-5250, USA. rvianna@iupui.edu
Mangus
Richard S
RS
Fridell
Jonathan A
JA
Kazimi
Marwan
M
Hollinger
Edward
E
Tector
Joseph
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007196:Indiana; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D016730:Program Development / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome