Comparable outcomes in intestinal retransplantation

Single-center cohort study

Burcin Ekser, Chandrashekhar A. Kubal, Jonathan A. Fridell, Richard Mangus

Research output: Contribution to journalArticle

Abstract

Background: Graft loss in intestinal transplantation (ITx) is close to 25% in the first year and 50% at 5-year post-transplantation. Although technically and immunologically challenging, intestinal retransplantation is now the 4th most common indication for ITx. Methods: The aim of this study was to review and compare the outcomes of intestinal retransplantation with primary ITx, which included isolated ITx, modified multivisceral transplantation (mMVTx), and full MVTx, between 2003 and 2014 at Indiana University. Results: Of 218 ITx, 18 (8.3%) were retransplantation. Causes of graft loss were rejection(78%), pancreatitis (11%), and severe intestine dismotility (11%). MVTx (16/18, 89%) was the preferred retransplantation option. In 7 (39%) patients, graftectomy was performed between primary and intestinal retransplantation. Median interval between primary ITx and retransplantation was 421 days. Although patient and graft survival rates at 1 year, 3 years, and 5 years were comparable between primary and retransplants, the number of retransplants was limited in the follow-up after post-transplant year 3. Conclusions: We identified that timing of retransplantation, graftectomy prior to retransplant allowing an immunosuppression free state, inclusion of the liver, and preserved renal function are important factors in the consideration of intestinal retransplantation. Immunological aspects remain challenging in the decision making and for short- and long-term outcomes.

Original languageEnglish (US)
Article numbere13290
JournalClinical Transplantation
Volume32
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Cohort Studies
Transplantation
Transplants
Graft Survival
Pancreatitis
Immunosuppression
Intestines
Decision Making
Survival Rate
Kidney
Liver
Rejection (Psychology)

Keywords

  • intestinal transplantation
  • multivisceral transplantation
  • outcome
  • retransplantation
  • small bowel transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Comparable outcomes in intestinal retransplantation : Single-center cohort study. / Ekser, Burcin; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Mangus, Richard.

In: Clinical Transplantation, Vol. 32, No. 7, e13290, 01.07.2018.

Research output: Contribution to journalArticle

Ekser, Burcin ; Kubal, Chandrashekhar A. ; Fridell, Jonathan A. ; Mangus, Richard. / Comparable outcomes in intestinal retransplantation : Single-center cohort study. In: Clinical Transplantation. 2018 ; Vol. 32, No. 7.
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abstract = "Background: Graft loss in intestinal transplantation (ITx) is close to 25{\%} in the first year and 50{\%} at 5-year post-transplantation. Although technically and immunologically challenging, intestinal retransplantation is now the 4th most common indication for ITx. Methods: The aim of this study was to review and compare the outcomes of intestinal retransplantation with primary ITx, which included isolated ITx, modified multivisceral transplantation (mMVTx), and full MVTx, between 2003 and 2014 at Indiana University. Results: Of 218 ITx, 18 (8.3{\%}) were retransplantation. Causes of graft loss were rejection(78{\%}), pancreatitis (11{\%}), and severe intestine dismotility (11{\%}). MVTx (16/18, 89{\%}) was the preferred retransplantation option. In 7 (39{\%}) patients, graftectomy was performed between primary and intestinal retransplantation. Median interval between primary ITx and retransplantation was 421 days. Although patient and graft survival rates at 1 year, 3 years, and 5 years were comparable between primary and retransplants, the number of retransplants was limited in the follow-up after post-transplant year 3. Conclusions: We identified that timing of retransplantation, graftectomy prior to retransplant allowing an immunosuppression free state, inclusion of the liver, and preserved renal function are important factors in the consideration of intestinal retransplantation. Immunological aspects remain challenging in the decision making and for short- and long-term outcomes.",
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