Adult Intestinal and Multivisceral Transplantation: Experience From a Single Center in the United Kingdom.
Cambridge is one of two designated adult intestinal transplant centers in the United Kingdom and has performed 60 transplants on 54 patients since 2007; 52% of these were undertaken in the last 3 years. This increasing trend is in contrast with that reported worldwide; 27% were small bowel grafts (SBT), 15% modified multivisceral (MMVT), and 58% multivisceral (MVT). Median recipient age was 47 years; the female-to-male ratio was 27/33. Primary diseases included visceral arterial thromboses (17%), Crohn's disease (17%), motility disorders (12%), visceral venous thromboses (12%), familial adenomatous polyposis (FAP)/desmoids (8%), alcoholic cirrhosis (3%), nonalcoholic fatty liver disease (3%), ulcerative colitis (2%), and other (15%). Indications for transplant included intestinal failure-associated liver disease (IFALD) (27%), loss of central venous access (17%), FAP/desmoid disease (5%), extensive portomesenteric venous thrombosis (PMVT) (20%), widespread mesenteric arterial ischemia (WMAI) (13%), re-transplant (8%), and other (10%). Overall 1-year/5-year patient survival rates were 77%/62%. One-year/5-year patient survival rates were 92%/83%, 85%/65%, and 71%/33% for SBT, MMVT, and MVT. One-year/5-year survival rates for patients with IFALD, PMVT, and other indications who underwent MVT were 80%/20%, 65%/55%, and 55%/35%. The greatest proportion of patient deaths occurred during the first year after transplant (50% in year 1, 23% in year 2, 9% in year 3, 5% in year 4, and 14% in year 5), particularly in the MVT group. Referrals to our United Kingdom center are increasing, and the indications for transplant are becoming more diverse. Our patient survival rates remain comparable with figures reported worldwide.
Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom. Electronic address: crutter@nhs.net.
C S
CS
Rutter
Department of Transplant Surgery, Cambridge University Hospitals, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
I
I
Amin
Department of Transplant Surgery, Cambridge University Hospitals, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
N K
NK
Russell
Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
L M
LM
Sharkey
Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
A J
AJ
Butler
Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
S J
SJ
Middleton
D000293:Adolescent; D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult