Ten-Year Experience With Bowel Transplantation at Seoul St. Mary's Hospital.
A retrospective review of intestinal transplantation (ITx) at Seoul St. Mary's Hospital was made by collecting clinical data over the past 10 years. Fifteen consecutive cases from 2004 were analyzed. Five children and 10 adults (6 months to 69 years of age) were included. Primary diseases in adults included 4 mesenteric vessel thromboses, 2 strangulations, and 1 each of visceral myopathy, malignant gastrointestinal stromal tumor (GIST), mesenteric lymphangiectasis, and injury. Pediatric cases involved 2 Hirschsprung disease, 2 visceral myopathy, and 1 necrotizing enterocolitis. Three of 7 stomas were closed using a serial transverse enteroplasty procedure before transplantation. The ITx were performed using 3 living-donor Itx, 12 deceased-donor ITx, 14 isolated Itx, and 1 modified multivisceral transplantation. Daclizumab, basiliximab, alemtusumab, or basiliximab with rabbit antithymocyte globulin (rATG) was used for the induction; tacrolimus monotherapy was used as the basic maintenance immunosuppressant; and m-TOR inhibitor was used for renal dysfunction patients. Seven cases of acute cellular rejection were treated with rATG. Three cases of antibody-mediated rejection were treated with rituximab alone or with rituximab and bortezomib combination. There were 4 cases of early mortality within 6 months after Itx. Causes of death were declamping shock, cardiac tamponade with acute cellular rejection, dysmotility, and sepsis. Surgical complications consisted of 1 feeding jejunostomy displacement, and a minor leakage at a colo-colostomy site. One-year survival of the patient and graft was 73.33% (Kaplan-Meier survival curve). Although the total number of ITx is small, its social impact has been remarkable in changing the related laws and reimbursement policy in Korea.
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
H K
HK
Chang
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
S Y
SY
Kim
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
J I
JI
Kim
Department of Internal Medicine, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
S I
SI
Kim
Department of Surgery, Daejeon St. Mary's Hospital, Daejeon, The Catholic University of Korea, Seoul, Korea.
J K
JK
Whang
Department of Internal Medicine, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
J Y
JY
Choi
Department of Internal Medicine, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
J M
JM
Park
Department of Pathology, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
E S
ES
Jung
Department of Radiology, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
S E
SE
Rha
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
D G
DG
Kim
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
I S
IS
Moon
Department of Surgery, Intestinal Transplantation and Rehabilitation Unit, Organ Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. Electronic address: Lmyungd@catholic.ac.kr.
M D
MD
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000077552:Basiliximab; D002648:Child; D002675:Child, Preschool; D000077561:Daclizumab; D005260:Female; D005767:Gastrointestinal Diseases / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection / Q000401:mortality; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D056910:Republic of Korea; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077561:Daclizumab; D016559:Tacrolimus