Intestinal and multivisceral transplantation at the University of Miami.
At the University of Miami Liver and GI Transplant Program, over 300 intestinal transplant procedures were performed in the last 15 years in adult and pediatric recipients. Good patient and graft survival rates are now achievable. Rejection remains the complication that is most difficult to prevent and manage. Induction with antilymphocyte agents, followed by maintenance with tacrolimus, is the preferred immunosuppression protocol at our center. We have expanded the use of multivisceral transplantation in pediatric recipients with short gut and significant liver dysfunction from parenteral nutrition. We also advocate the use of large intestine as part of the intestinal graft as well as inclusion of the spleen in multivisceral grafts, which in our experience can be safely accomplished. The future of intestinal transplantation lies in the use of noninvasive markers of intestinal rejection, and continued refinements in immunosuppression protocols.
University of Miami, Miller School of Medicine, Miami Transplant Institute, Miami, Florida, USA.
Gennaro
G
Selvaggi
Seigo
S
Nishida
David
D
Levi
Jang
J
Moon
Eddie
E
Island
Akin
A
Tekin
Debbie
D
Weppler
Andreas
A
Tzakis
D002102:Cadaver; D005431:Florida; D006086:Graft vs Host Disease / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology; D007422:Intestines / Q000637:transplantation*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D017741:Survivors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014781:Viscera / Q000637:transplantation*
D007166:Immunosuppressive Agents