A team from Los Angeles, California, USA, investigated the outcomes after intestinal transplantation at a tertiary medical care center, between 1991 and 2000.
A total of 17 patients with intestinal failure (5 adult, 12 pediatric) were recruited to the study. Their median age and weight were 8.6 years and 22 kg, respectively.
All had developed complications from long-term total parenteral nutrition therapy.
Primary intestinal transplantation was conducted with the liver in 14 patients, and without the liver in 3 patients.
The researchers measured patient and graft survival, viral infections, rejection, and nutritional autonomy.
Some 21 intestinal grafts were transplanted into the 17 recipients.
All donors were cadaveric, and were matched by ABO blood group and size.
| Patient survival after transplantation:|
1 year: 63%
3 years: 55%
|Archives of Surgery |
The investigators found that the patient survival at 1 and 3 years was 63% and 55%, respectively. Death-censored graft survival at 1 and 3 years was 73% and 55%, respectively.
There were 1.5 acute cellular rejection episodes per graft and 3 grafts were lost to rejection.
Incidences of infection with the Epstein-Barr virus and cytomegalovirus were found to be negligible with aggressive prophylaxis and preemptive therapy.
Nutritional autonomy was achieved in 69% of grafts surviving more than 30 days after intestinal transplantation.
Dr Douglas G. Farmer, of the University of California, Los Angeles, said on behalf of the group, "Intestinal transplantation is now the standard of therapy for patients with intestinal failure and complications resulting from total parenteral nutrition.
"Outcomes have markedly improved since initiation of the program.
"Aggressive immunosuppression, as well as prophylaxis and pre-emptive antiviral therapy, have led to low incidences of acute cellular rejection, Epstein-Barr virus, and cytomegalovirus.
"Finally, nutritional autonomy can be achieved after successful intestinal transplantation," he concluded.