title: Intestinal Graft Failure: Should We Perform the Allograft Enterectomy Before or With Retransplantation?
abstract: Intestinal graft dysfunction is sometimes irreversible and requires allograft enterectomy with or without retransplantation. There is no comprehensive assessment of allograft enterectomy regarding indications and outcomes. The aim of this study was to evaluate management of patients with intestinal graft failure with special reference to indications and outcomes of allograft enterectomy and the procedure's validity as a bridge to retransplantation.
  
  
  
  Graft and patient survivals, reason for graft failure, and rejection episodes were evaluated in 221 intestinal recipients (primary transplantation [n = 201], retransplantation [n = 20]). Indications, surgical factors, and outcomes of allograft enterectomy were investigated.
  
  
  
  Reasons for isolated enterectomy included systemic infection in 11, gastrointestinal bleeding in 1, and severe electrolyte imbalance in 1, all of which were associated with rejection. One isolated intestinal transplantation patient underwent isolated enterectomy due to cytomegalovirus enteritis. One multivisceral transplantation patient underwent isolated allograft enterectomy due to bowel necrosis. Of these 15 patients, 3 died from persistent infection postoperatively, whereas 8 underwent retransplantation with median interval of 74 days (42-252 days). Allosensitization occurred between isolated enterectomy and retransplantation in 2, one of whom lost the second graft due to rejection. Simultaneous allograft enterectomy and retransplantation was performed in 3 isolated intestinal transplantation and 9 multivisceral transplantation patients. Patient survival after retransplantation was similar between patients who underwent isolated allograft enterectomy and those who did simultaneous enterectomy with retransplantation (P = 0.82).
  
  
  
  In cases of irreversible intestinal graft dysfunction, isolated allograft enterectomy successfully provides recovery from comorbidities as a lifesaving procedure and does not compromise outcomes of retransplantation.
authors.affiliation: 1 Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. 2 Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: Eve
authors.initials: E
authors.lastname: Anderson
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.forename: Chandrashekhar A
authors.initials: CA
authors.lastname: Kubal
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007196:Indiana; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents