Abstracts

INTESTINAL AND MULTIVISCERAL TRANSPLANTATION FOR PATIENTS WITH ABDOMINAL MALIGNANCY: DISEASE RECURRENCE AND SURVIVAL OUTCOME

June Stamos, Lillian Martin, Darlene Koritsky, Georgetta Walsh, Karen Laughlin, Bonnie Schuster, Guilherme Costa, Geoffrey Bond, Kareem Abu-Elmagd. Surgery, University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Purpose:  During the evolution phase of intestinal transplantation, patients with history of abdominal malignancy were cautiously considered for transplantation. This is the first report to address the therapeutic efficacy of the procedure in this high-risk population.

Methods:  Between May 1990 and December 2005, 188 adult patients underwent intestinal transplantation; 48% intestine alone, 20% liver-intestine and 32% multivisceral. Of these, 14 had histologically documented primary abdominal malignancy; gastrinoma(n=1), GIST(n=1), pancreatic(n=1), colorectal(n=4), hepatocellular(n=1), testicular (n=2), ovarian(n=2), and renal cell(n=2). The gender distribution was equal with a median age of 45 years. Short gut syndrome was the primary indication for transplantation in 12 patients due to irradiation enteritis(n=5), surgical adhesions(n=2), volvulus(n=1), vascular injury(n=2), and therapeutic enterectomy(n=2). In the remaining 2 cases, multivisceral replacement was required for portomesenteric thrombosis and radical excision of metastatic gastrinoma. Replacement of the native liver was indicated in 7 of the 14 patients. The cancer diagnosis was made before transplantation (1 1/2-32 yrs) in 12 patients and was incidental in the remaining 2. One of the incidental carcinoma was hepatocellular in a multivisceral recipient and renal cell in an isolated intestinal recipient who required native nephrectomy at the time of transplant. The thorough pretransplant evaluation failed to identify any clinical, biochemical, or radiologic evidences of primary or recurrent malignancy.

Results:  With a mean post-transplant follow-up of 35 + 38 months, 10(71%) patients are currently alive with fully functioning grafts. Only 1 of the 4 deaths was due to metastatic adenocarcioma of unknown origin at 21 months from time of transplantation and 60 months from diagnosis of in-situ anal squamous cell carcinoma. Despite the need for chronic heavy post-transplant immunosuppression, none of the visceral recipients showed evidence of recurrent carcinoma at the time of death(n=4) or current follow-up with 1 to 31 years from cancer diagnosis(n=10).

Conclusions:  History or presence of non-metastatic abdominal malignancy should not be considered as contraindication for intestinal or multivisceral transplantation.

Top Updated 9/19/0