title: Long-term survival, nutritional autonomy, and quality of life after intestinal and multivisceral transplantation.
abstract: OBJECTIVE
  To assess long-term survival, graft function, and health-related quality of life (QOL) after visceral transplantation.
  
  
  BACKGROUND
  Despite continual improvement in early survival, the long-term therapeutic efficacy of visceral transplantation has yet to be defined.
  
  
  METHODS
  A prospective cross-sectional study was performed on 227 visceral allograft recipients who survived beyond the 5-year milestone. Clinical data were used to assess outcome including graft function and long-term survival predictors. The socioeconomic milestones and QOL measures were assessed by clinical evaluation, professional consultation, and validated QOL inventory.
  
  
  RESULTS
  Of 376 recipients, 227 survived beyond 5 years, with conditional survival of 75% at 10 years and 61% at 15 years. With a mean follow-up of 10 ± 4 years, 177 (92 adults, 85 children) are alive, with 118 (67%) recipients 18 years or older. Nonfunctional social support and noninclusion of the liver in the visceral allograft are the most significant survival risk factors. Nutritional autonomy was achievable in 160 (90%) survivors, with current serum albumin level of 3.7 ± 0.5 gm/dL and body mass index of 25 ± 6 kg/m(2). Despite coexistence or development of neuropsychiatric disorders, most survivors were reintegrated to society with self-sustained socioeconomic status. In parallel, most of the psychological, emotional, and social QOL measures significantly (P < 0.05) improved after transplantation. Current morbidities with potential impact on global health included dysmotility (59%), hypertension (37%), osteoporosis (22%), and diabetes (11%), with significantly (P < 0.05) higher incidence among adult recipients.
  
  
  CONCLUSIONS
  With new tactics to further improve long-term survival including social support measures, visceral transplantation has achieved excellent nutritional autonomy and good QOL.
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. abuelmagdkm@upmc.edu
authors.forename: Kareem M
authors.initials: KM
authors.lastname: Abu-Elmagd
authors.forename: Beverly
authors.initials: B
authors.lastname: Kosmach-Park
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: Mazen
authors.initials: M
authors.lastname: Zenati
authors.forename: Lillian
authors.initials: L
authors.lastname: Martin
authors.forename: Darlene A
authors.initials: DA
authors.lastname: Koritsky
authors.forename: Maureen
authors.initials: M
authors.lastname: Emerling
authors.forename: Noriko
authors.initials: N
authors.lastname: Murase
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Bond
authors.forename: Kyle
authors.initials: K
authors.lastname: Soltys
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sogawa
authors.forename: John
authors.initials: J
authors.lastname: Lunz
authors.forename: Motaz
authors.initials: M
authors.lastname: Al Samman
authors.forename: Nico
authors.initials: N
authors.lastname: Shaefer
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sindhi
authors.forename: George V
authors.initials: GV
authors.lastname: Mazariegos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D007422:Intestines / Q000637:transplantation*; D016030:Kidney Transplantation / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D016031:Liver Transplantation / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012944:Social Support; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult