Abstracts

EARLY INTESTINAL TRANSPLANATION FOR PATIENTS WITH ACUTE IRREVERSIBLE INTESTINAL FAILURE

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

Purpose: With the cumulative improvement in survival outcome, intestinal transplantation(IT) has been recently considered for patients with acute intestinal failure(AIF) who do not fulfill the current standard criteria including TPN failure. The aim of this study is to outline the indications and outcomes after IT for AIF.

Methods: Between July 2000 and December 2005, 18(20%) out of 91 adult consecutive patients underwent IT within 6 months from the onset of TPN therapy and before the development of TPN failure with a median of 3(range: 0.56) months. Five patients were male and 13 were female with a mean age of 38 + 13(range: 18-57). The primary causes of intestinal failure were vascular thrombosis (n=6), volvulus(n=5), Crohns disease(n=3), trauma(n=2), desmoid tumor(n=1) and surgical adhesions(n=1). The indications for early transplantation were ultra-short gut syndrome/active duodenopancreatic fistulae(n=14), portal/hepatic artery thrombosis(n=2), extra-gastrointestinal autoimmune diseases(n=1) and brittle diabetes(n=1). The blood type was O in 8, A in 8, and AB in 2. The cytomegaloviral serology was negative in 8 and positive in 10 patients. Fifteen patients underwent an isolated IT and the remaining 3 required an allograft that contained the stomach and/or pancreas en-bloc with the intestine.

Results: With a mean follow-up of 35 +14 (range:6-66) months, 3 patients died with an overall survival rate of 83%. All of the 15 current survivors achieved full nutritional autonomy enjoying unrestricted oral diet. As expected, the postoperative course for most patients was uneventful and the initial hospitalization was relatively short with a median of 23 days. In addition, all of the 12 patients that received the tolerogenic immunosuppressive protocol are currently on spaced doses of tacrolimus free of steroid therapy. Of particular interest is the full restoration of the nutritional autonomy and normalization of patient lifestyle at an earlier time compared to recipients transplanted after development of TPN failure.

Conclusion: Early consideration for IT and before the development of TPN failure is associated with successful outcomes. Accordingly, the current existing criteria that mandates TPN failure and restricts the utilization of IT should be lifted.