Background: Some patients with intestinal failure have life threatening TPN complications. Intestinal transplantation has became the lifesaving alternative for these patients.
Methods: We reviewed 95 consecutive intestinal transplants performed between December 1994 and November 2000 at the University of Miami.
Results: Fifty-four cases are pediatric and 41 cases are adult. Forty-nine cases are male and 46 cases are female. The causes of the intestinal failure were as follows; Mesenteric thrombosis (n=12), Necrotizing Enterocolitis (n=11), Gastroschesis (n=11), Voluvulus (n=9), Desmoid tumor (n=8), Intestinal atresia (n=6), Trauma (n=5), Hirschsprung's disease (n=5), Crohn's disease (n=5), Pseudoobstruction (n=4) and other (n=19). All patients had TPN related complications including 67 patients with liver failure. Isolated intestinal transplantation (I) was performed in 27 cases, liver and intestinal transplantation (LI) in 28 cases and multivisceral transplantation (MV) in 40 cases. Mean cold ischemic time was 480±12.3 min. Mean warm ischemic time was 39.0±1.07 min. The 1-yr patient and graft survivals of isolated intestinal transplant were 75% and 68%. The 1-yr patient and graft survivals of isolated intestinal transplantation since 1998 were 84% and 72%. The 1-yr patient and graft survivals of all cases were 52% and 45%. The 1-yr patient and graft survivals of all cases since 1998 were 60% and 50%. The 1-yr patient survival of LI and MV were 40% and 48%. The incidence of severe rejection has decreased since 1998. Since 1998, we have been using zoomvideoendoscope and induction with Daclizumab. The cause of death were as follows; Sepsis after rejection (n=14). Respiratory failure (n=8), Sepsis (n=6), Multiple organ failure (n=4), Arterial graft infection (n=3), Aspergillosis (n=2), PTLD (n=2), Intracranial bleeding (n=2), Fungemia (n=1), Chronic rejection (n=1), GVHD (n=1), Necrotizing Enterocolitis (n=1), Pancreatitis (n=1), Pulmonary embolism (n=1), Viral encephalitis (n=1).
Conclusions: Intestinal transplantation provided a lifesaving alternative for patients with intestinal failure. Patient and graft survival following isolated intestinal transplantation were better than those of liver-intestinal transplantation and multivisceral transplantation. The prognosis following intestinal transplantation is better when performed prior to the onset of liver failure. Patient selection, zoomvideoscope and Daclizumab have contributed to the improvement in patient survival.