Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.
BACKGROUND
Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation.


METHODS
This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported.


RESULTS
A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002).


CONCLUSIONS
At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Ramisch
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Rumbo
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Echevarria
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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L
Moulin
Anesthesia Department, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Niveyro
Anesthesia Department, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Orce
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Crivelli
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Martinez
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Chavez
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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MA
Paez
Pediatric Intensive Care Unit, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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J
Trentadue
Adult Intensive Care Unit, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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F
Klein
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Fernández
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina.
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Solar
Instituto de Trasplante Multiorgánico, Unidad de Insuficiencia Intestinal, Rehabilitación y Trasplante de Intestino, Hospital Universitario, Fundación Favaloro, CABA, Argentina. Electronic address: ggondolesi@ffavaloro.org.
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Gondolesi
D000328:Adult; D001118:Argentina; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000601:surgery*; D014850:Waiting Lists; D052096:Warm Ischemia