title: Isolated intestinal transplant for chronic intestinal pseudo-obstruction in adults: long-term outcome.
abstract: BACKGROUND
  Chronic intestinal pseudo-obstruction (CIPO) has been treated in adults by total parenteral nutrition (TPN) or, if complications arise, by multivisceral transplantation because the stomach is often involved. Eleven adults with CIPO were transplanted by intestinal graft in our center from 2000 to 2011.
  
  
  METHODS
  Nine patients underwent isolated intestinal transplant and 2 patients had multivisceral transplant. Immunosuppression was represented by FK and steroids plus induction with alemtuzumab, daclizumab, or thymoglobulin. Average age at transplant was 33.5 years. We reported 1 graftectomy, followed by retransplantation.
  
  
  RESULTS
  Seven patients are currently alive with working small bowel; cause of death was infection in the 4 remaining cases. In 9 isolated intestinal transplants, we performed different digestive reconstructions to allow gastric emptying. In 2 cases we were forced, after transplant, to perform ileostomy to improve intestinal motility. Graft and patient survival after 5 years are 60% and 70%, respectively, while after 10 years, 45% and 56%, respectively.
  
  
  CONCLUSIONS
  Adults with CIPO and irreversible TPN complications benefit from isolated intestinal transplant with different surgical techniques to empty the native stomach: this strategy achieves good gastric emptying, with effective establishment of oral feeding and graft and patient survivals comparable to isolated intestinal transplant for short bowel syndrome.
authors.affiliation: General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, Italy. Electronic address: augustola@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.forename: S
authors.initials: S
authors.lastname: Pellegrini
authors.forename: F
authors.initials: F
authors.lastname: Catena
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: N
authors.initials: N
authors.lastname: Cautero
authors.forename: V
authors.initials: V
authors.lastname: Stanghellini
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007418:Intestinal Pseudo-Obstruction / Q000601:surgery*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents