Liver and gastrointestinal transplantation at the University of Miami

Abstract

The field of liver and intestinal transplantation is continuously evolving. At present, we cannot escape the need for long-term immunosuppression. Management of side effects and complications of immunosuppression is difficult, as well as recurrence of viral disease after transplantation. Similar challenges are present in virally induced diseases such as PTLD. The clinical applicability of tolerance inducing protocols in the future will rely more and more on the ability to decrease the total amount of immunosuppression given around the time of transplant. The introduction of induction protocols using Campath 1-H has allowed us to decrease the average dose of calcineurin inhibitors and virtually avoid the use of steroids. We have been able to achieve, at least in the short run, patient and graft survivals similar to historical controls, without any added infectious complication. It has still to be proven whether these short-term results will translate in longterm avoidance of calcineurin inhibitors nephrotoxicity and steroid-related diabetes, osteoporosis and so forth. We continue to pursue an active program of intestinal and combined liver-intestinal or multivisceral transplantation, with survival rates constantly improving. The monitoring of graft function and rejection represents the major challenge in intestinal transplantation. The development of laboratory tests such as citrulline levels, combined with the use of advanced endoscopic techniques such as the use of the zoom video endoscope has allowed us to integrate the clinical and histopathological information in an effort to diagnose early and treat appropriately intestinal rejection.