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Clinical Trial
. 2019 Jul;19(7):2077-2091.
doi: 10.1111/ajt.15269. Epub 2019 Mar 26.

Long-term survival in visceral transplant recipients in the new era: A single-center experience

Ahmed M Elsabbagh  1   2   3 , Jason Hawksworth  1   4 , Khalid M Khan  1 , Stuart S Kaufman  1 , Nada A Yazigi  1 , Alexander Kroemer  1 , Coleman Smith  1 , Thomas M Fishbein  1 , Cal S Matsumoto  1
Affiliations
Clinical Trial

Long-term survival in visceral transplant recipients in the new era: A single-center experience

Ahmed M Elsabbagh et al. Am J Transplant. 2019 Jul.

Abstract

There is a paucity of data on long-term outcomes following visceral transplantation in the contemporary era. This is a single-center retrospective analysis of all visceral allograft recipients who underwent transplant between November 2003 and December 2013 with at least 3-year follow-up data. Clinical data from a prospectively maintained database were used to assess outcomes including patient and graft survival. Of 174 recipients, 90 were adults and 84 were pediatric patients. Types of visceral transplants were isolated intestinal transplant (56.3%), combined liver-intestinal transplant (25.3%), multivisceral transplant (16.1%), and modified multivisceral transplant (2.3%). Three-, 5-, and 10-year overall patient survival was 69.5%, 66%, and 63%, respectively, while 3-, 5-, and 10-year overall graft survival was 67%, 62%, and 61%, respectively. In multivariable analysis, significant predictors of survival included pediatric recipient (P = .001), donor/recipient weight ratio <0.9 (P = .008), no episodes of severe acute rejection (P = .021), cold ischemia time <8 hours (P = .014), and shorter hospital stay (P = .0001). In conclusion, visceral transplantation remains a good option for treatment of end-stage intestinal failure with parenteral nutritional complications. Proper graft selection, shorter cold ischemia time, and improvement of immunosuppression regimens could significantly improve the long-term survival.

Keywords: clinical research/practice; health services and outcomes research; immunosuppressive regimens - induction; intestinal (allograft) function/dysfunction; intestine/multivisceral transplantation.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1.
Figure 1.
Number of intestinal transplantations per year.
Figure 2.
Figure 2.
Patient survival
Figure 3.
Figure 3.
Graft survival
Figure 4.
Figure 4.
Impact of graft type on patient survival (P=0.111)
Figure 5.
Figure 5.
Impact of pediatric and adult groups on patient survival (P= 0.004)
Figure 6.
Figure 6.
Impact of donor/recipient weight ratio on patient survival (P= 0.010)
Figure 7.
Figure 7.
Impact of Cold Ischemia Time (CIT) on patient survival (P= 0.005)
Figure 8.
Figure 8.
Impact of severe acute rejection on patient survival (P= 0.010)
See this image and copyright information in PMC

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