Clinical Experience of Isolated Intestinal Transplantation in Adult: A Report of 29 Consecutive Series

Takuya Kimura, Augusto Lauro, Matteo Cescon, Chiara Zanfi, Antonio Daniele Pinna and Masahiro Fukuzawa*

Liver and Multiorgan Transplant Unit, S'Orsola-Malpighi Hospital, University of Bologna
Division of Pediatric Surgery, Department of Surgery, Osaka University Graduate School of Medicine*

Introduction: We review our work in adult intestinal transplantation at a European single center. Patients and Methods: In the last 7 years, we have conducted 29 isolated intestinal transplants in 28 adults whose underlying diseases were short bowel syndrome (17), intestinal failure (9), and intestinal tumors (2). Transplant indications were loss of venous access (15), recurrent sepsis (12) and electrolyte fluid imbalance (5). Immunosuppression was based on monoclonal antibodies using induction therapy. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance. After 2002, we applied alemtuzumab or antithymocyte globulin as an induction agent with low-dose tacrolimus monotherapy maintenance. Results: Median follow-up was 977 days. Actuarial 5-year patient survival was 74% and graft survival 71%. Death was caused by sepsis and graftectomy mainly by rejection unresponsive to anti-rejection therapy. Among the 22 recipients alive, 19 (86%) have normal bowel function with a regular diet without parenteral support. Conclusions: Isolated intestinal transplantation in adults had 5-year patient and graft survival rates similar to those in other solid organ transplantation. Intestinal transplantation thus appears to be an effective alternative in patients with intestinal failure and/or short bowel syndrome; however, further study is needed to establish as standard treatment.

Key words
intestinal transplantation, small bowel transplantation, short bowel syndrome, intestinal failure, total parenteral nutrition

Reprint requests
Takuya Kimura Division of Pediatric Surgery, Department of Surgery, Osaka University Graduate School of Medicine
2-2 Yamadaoka, Suita, 565-0871 JAPAN

Accepted
May 21, 2008

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