Five Hundred Intestinal and Multivisceral Transplantations at a Single Center

Abstract

Survival has greatly improved over time as management strategies evolved. The current results clearly justify elevating the procedure level to that of other abdominal organs with the privilege to permanently reside in a respected place in the surgical armamentarium. Meanwhile, innovative tactics are still required to conquer long-term hazards of chronic rejection of liver-free allografts and infection of multivisceral recipients.

Increased Expression of Peripheral Blood Leukocyte Genes Implicate CD14+ Tissue Macrophages in Cellular Intestine Allograft Rejection

“…1,2,11 Both agents contain antibody specificities directed against a variety of PBL subsets, including T and B cells. Alemtuzumab was given to the more recent ITx recipients, to reduce the incidence of early ACR in children, based on recent success in adult ITx recipients.…”

“…Alemtuzumab was given to the more recent ITx recipients, to reduce the incidence of early ACR in children, based on recent success in adult ITx recipients. 1 All children received tapering doses of steroids, and the T-cell immunosuppressant tacrolimus titrated to whole blood concentrations (FKWBC) 10 to 15 ng/mL during the first 90 days, and tapered to 5 to 10 ng/mL toward the end of the first year. 2,10 The frequency of protocol biopsies was weekly in the first month, twice monthly during the second month, and monthly thereafter until closure of the allograft stoma.…”

“…Within 5 years after ITx, 15% of recipients have progressed to chronic rejection and graft loss. 1,2 The association between early and recurrent rejection suggests that the early rejector who develops recurrent episodes and the recipient who is rejection-free early after transplantation represent two contrasting outcome groups in which to study the mechanisms of early and progressive allograft injury. The high incidence of recurrent rejection after ITx has not been eliminated with high-dose prophylactic immunosuppression with anti-Tcell agents or aggressive surveillance with frequent protocol biopsies.…”

Combined Intestine and Kidney Transplantation in a Patient With Encapsulating Peritoneal Sclerosis: Case Report

“…First and foremost outcomes after intestinal transplantation are less than ideal and far inferior to other solid organ transplants. Based on the largest single-center experience of 453 intestinal and multivisceral transplants (15), the overall 5-year patient and graft survival rates were 61% and 50%, respectively. Moreover, the 5-year graft survival rate for isolated intestinal transplant recipients was 44%.…”

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

“…97 Since then, its shortterm outcomes have improved significantly and indications of either intestinal, liver-intestinal, or multivisceral (full/modified) transplantations 98 have expanded for a wide variety of tumors such as desmoid (Gardner's syndrome), neuroendocrine, adenocarcinoma, schwannoma, lymphoma, and sarcoma that would otherwise be unresectable. [99][100][101][102][103][104][105][106][107][108][109][110][111][112] Currently, there is no standardized indication of intestinal and multivisceral transplantation for neoplastic disease. However, for high-grade malignancies such as adenocarcinoma and lymphoma, the disappointing oncological results in the earlier series obviously warrant deliberate patient selection, if not contraindicated.…”