Isolated intestinal transplantation is limited by poor patient and graft survival.
Achieving high survival and reversing parenteral nutrition-associated liver disease could allow isolated intestinal transplantation to be more widely applied
In this study, doctors from the United States evaluated 26 patients who had failed parenteral nutrition and who received 28 isolated intestinal transplants.
The team analyzed patient and graft survival, as well as the effect of sirolimus on the severity and frequency of rejection. They also assessed the reversibility of liver dysfunction after transplant.
The physicians determined that 3-year actuarial patient survival was 88%, and primary graft survival was 71%.
Of the 26 patients, 2 underwent successful retransplants.
Overall, 22 patients were alive at a mean of 21 months after transplant.
|Early rejection occurred less frequently with sirolimus.|
Furthermore, actuarial survival without parenteral nutrition is 81% at 3 years. Additionally, actuarial freedom from parenteral support among survivors is 96% at 3 years.
The researchers found that early rejection occurred less frequently with sirolimus (34%), than without (70%).
In addition, both moderate and severe rejection was less frequent with sirolimus. The team found that no grafts were lost after introduction of sirolimus.
Overall, the team found that all 4 patients with advanced liver dysfunction, fibrosis and cholestasis regressed within 1 year.
Dr Thomas Fishbein's team concluded, "High patient survival and parenteral nutrition-free survival can be achieved after isolated intestinal transplantation".
"Sirolimus treatment has eliminated graft loss".
"Parenteral nutrition-associated liver disease is reversible with intestinal transplantation".
"Refractory liver dysfunction in patients receiving parenteral nutrition should prompt consideration for isolated intestinal transplantation".