Long Term Outcomes after Intestinal Transplantation from a Single South American Center, Lessons Learned.

CONSTANZA ECHEVARRÍA; DIEGO RAMISCH; GUILLERMO ORCE; LUIS MOULIN; LILA CHAVEZ; FRANCISCO KLEIN; ADRIANA CRIVELLI; GABRIEL E. GONDOLESI; MARIA DE LOS ANGELES PAEZ; ADRIANA FERNANDEZ; CAROLINA RUMBO; SILVIA NYVEIRO; MARIA INES MARTINEZ; JULIO TRENTADUE; HECTOR SOLAR MUNIZ

Congreso; TTS Madrid 2018; 2018

Background. Intestinal failure (IF) patients received parenteral nutrition (PN) as theonly 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 ITxperformed in pediatric and adult patients at a single center 9 years after its creation.Patients and Methods. This is a retrospective analysis of the ITx performed betweenMay2006and January 2015.Diagnoses, pre-ITxmean time onPN, indications for ITx, time on the waiting listfor types of ITx, mean total ischemia time, and warmischemia time, time until PNdiscontinuation,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 timeon PN was 1620 days. The main indication for ITx was lack of central venous access followed byintestinal failureeassociated liver disease (IFALD) and catheter-related infectious complications.The mean time on the waiting list was 188 days (standard deviation, 183 days). ITx wereperformed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 weremultiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 withkidney); 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 bythe same surgical team. Total ischemia time was 7:53 2:04 hours, and warm ischemia time was40.2 10.5 minutes. The mean length of implanted intestine was 325 63 cm. BishopeKoopileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. Theoverall mean follow-up time was 41 35.6 months. The mean time to PN discontinuation afterTx was 68 days (P ¼ .001). The total number of acute cellular rejection (ACR) episodes untilthe last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graftlost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is55% (65% for IITx vs 22% forMOT; P ¼ .0001); 60% for pediatric recipients vs 47% for adults(P ¼ NS); 64% when the indication for ITx was SG vs 25% for non-SG (P ¼ .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 multidisciplinaryapproach is mandatory for the care of intestinal failure patients, to sustain a rehabilitationand transplantation program over time.