Long Term Outcomes After Intestinal Transplantation From a Single South-American Center, Lessons Learned

DIEGO RAMISCH; CAROLINA RUMBO; CONSTANZA ECHEVARRIA; LUIS MOULIN; SILVIA NIVEYRO; GUILLERMO ORCE; ADRIANA CRIVELLI; MARIA I. MARTINEZ; LILA CHAVEZ; MARIA DE LOS ANGELES PAEZ; JULIO TRENATDUE; FRANCISCO KLEIN; ADRIANA FERNÁNDEZ,; HÉCTOR SOLAR; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Intestinal failure patients (IF) pts had the only option of parenteralnutrition (PN) as available therapy until intestinal transplantation (ITx)evolved as an accepted treatment.Aim: to report the long term outcomes of a series of ITx performedin pediatric and adults at a single center, 9 years after its creation.Material and Methods: retrospective analysis of the ITx performedbetween May 2006- January 2015. Diagnoses, pre ITx mean timeon PN, indication for ITx, time on the waiting list (WL), type of ITx,mean total ischemia time (TIT), and warm ischemia time (WIT), timeuntil PN discontinuation, 5 year actuarial patient survival are reported.Results: 42 pt received ITx; 80% had short gut syndrome (SG); themean time on PN was 1620 days*. The main indication for ITx waslack of central venous accesses (53%) followed by intestinal failureassociated liver disease (IFALD - 31,2%) and catheter related infectiouscomplications (19%). The mean time on the WL was 188 days(SD: 183 days). ITx were performed in 26 children and 14 adults.Thirty two procedures were isolated ITx (IITX); 10 multiorgan (MOT)(3 combined, 7 multivisceral ? 1 Modified MTV and 2 with kidney); 2(4,7 %) were re-transplants: 1 IITx, 1 MTV; 5 included right colon.Thirteen pts (31%) received the abdominal rectus fascia. All procedureswere performed by the same surgical team; TIT was 7:53±2:04hs, WIT was 40.2±10.5 min. Mean length of implanted intestine: 325± 63 cm, Bishop-koop ileostomy was performed in 67% of the cases.16/42 Tx required early re-operations. The overall mean follow uptime is 41±35.6 months. The mean time to PN discontinuation afterITX was 68 days (* p: 0,001); the overall 5 year pt survival is 55%;65% for IITx vs 22% for MOT (p=0,0001); 60% for pediatric recipientsvs 47% for adults (p=NS); 64% when indication was SG vs 25% forNon-SG (p=0,002); 62% for pts without IFALD vs 20% when IFALDwas present (p=0.003).Conclusions: Candidates with SG, in the absence of IFALD requiringIITx, showed to have best long term outcomes independently ofthe recipient age, at this center.