title: Fifteen years' experience of intestinal and multivisceral transplantation in the Nordic countries.
abstract: OBJECTIVE
  Intestinal and multivisceral transplantation have gained acceptance as treatment modalities for patients with: intestinal failure and life-threatening complications of parenteral nutrition (PN), rare cases of vascular abdominal catastrophes and selected cases of low-grade neoplastic tumors such as neuroendocrine pancreatic tumors and desmoids involving the mesenteric root. The aim was to describe the survival and nutritional outcome in the transplanted Nordic patients and the complications attributed to this procedure.
  
  
  METHODS
  The authors included all Nordic patients transplanted between January 1998 and December 2013. Information on patients transplanted outside the Nordic region was collected through questionnaires.
  
  
  RESULTS
  A total of 34 patients received different types of intestinal allografts. Currently, there are two Nordic transplant centers (n = 29) performing these procedures (Gothenburg, Sweden n = 24, Helsinki, Finland n = 5). The remaining five patients were transplanted in the USA (n = 3) and the UK (n = 2). Most patients were transplanted for life-threatening failure of PN (70%) caused primarily by intestinal motility diseases (59%). Allograft rejection was the most common complication and occurred in 79% of the patients followed by post-transplantation lymphoproliferative disorders (21%) and graft-versus-host disease (18%). The 1- and 5-year survival was 79% and 65% respectively for the whole cohort and nutritional autonomy was achieved in 73% of the adults and 57% of the children at 1 year after transplantation.
  
  
  CONCLUSIONS
  This collective Nordic experience confirms that intestinal transplantation is a complex procedure with many complications, yet with the possibility to provide long-term survival in selected conditions previously considered untreatable.
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Varkey
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Hannu
authors.initials: H
authors.lastname: Jalanko
authors.forename: Mihai
authors.initials: M
authors.lastname: Oltean
authors.forename: Robert
authors.initials: R
authors.lastname: Saalman
authors.forename: Audur
authors.initials: A
authors.lastname: Gudjonsdottir
authors.forename: Markus
authors.initials: M
authors.lastname: Gäbel
authors.forename: Helena
authors.initials: H
authors.lastname: Borg
authors.forename: Mats
authors.initials: M
authors.lastname: Edenholm
authors.forename: Oystein
authors.initials: O
authors.lastname: Bentdal
authors.forename: Steffen
authors.initials: S
authors.lastname: Husby
authors.forename: Michael
authors.initials: M
authors.lastname: Staun
authors.forename: Heikki
authors.initials: H
authors.lastname: Mäkisalo
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.forename: Mikko
authors.initials: M
authors.lastname: Pakarinen
authors.forename: Gustaf
authors.initials: G
authors.lastname: Herlenius
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007410:Intestinal Diseases / Q000628:therapy*; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D012537:Scandinavian and Nordic Countries; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Liver-containing allograft; allograft rejection; graft versus host disease; intestinal failure; intestinal transplantation; multivisceral transplantation; neuroendocrine pancreatic tumors; parenteral nutrition; post transplantation lymphoproliferative disorder