Initiation of an intestinal transplant program: The indiana experience

Rodrigo M. Vianna, Richard Mangus, Jonathan A. Fridell, Marwan Kazimi, Edward Hollinger, Joseph Tector

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

INTRODUCTION.: Establishment of a new intestinal transplant (Itx) program in the United States entails significant programmatic costs and a steep learning curve. We report results of the first 4 years of the program at Indiana University. METHODS.: Forty-six intestinal and multivisceral transplants (MVtx) were performed between 2003 and 2007. All organ procurements were performed by our team. Immunosuppression included an induction protocol combined with maintenance tacrolimus monotherapy. Scheduled rejection surveillance was with magnification endoscopy. RESULTS.: Forty-three patients (13 children and 30 adults) received 10 Itx (22%), 5 modified MVtxs (11%), and 31 (MVtx, 67%). Recipient ages ranged from 3 months to 66 years, with median follow-up time of 15 months. Thirty-five patients are currently alive (81%). Patient and graft survival at 30 days was 85%/86% in pediatric and 93%/91% in adult; overall survival was 69%/64% in pediatric and 87%/75% in adult. Thirty patients (69%) experienced episodes of rejection. Multivisceral transplanted patients experienced less episodes of severe rejection (2/31, 6%) when compared with patients with isolated Itx and modified MVtxs. Retransplantation was performed in three patients with nonresponsive severe acute rejection. CONCLUSION.: The Indiana University Intestinal and Multivisceral Transplant program experienced significant early graft loss and mortality among pediatric patients, but not among adults. This discrepancy resolved within 2 years of program initiation. After 4 years, adult and pediatric graft and patient survival statistics are similar to those at other programs.

Original languageEnglish
Pages (from-to)1784-1789
Number of pages6
JournalTransplantation
Volume85
Issue number12
DOIs
StatePublished - Jun 27 2008

Fingerprint

Transplants
Pediatrics
Graft Survival
Tissue and Organ Procurement
Learning Curve
Tacrolimus
Immunosuppression
Endoscopy
Maintenance
Costs and Cost Analysis
Survival
Mortality
Rejection (Psychology)

Keywords

  • Intestinal transplantation
  • Multivisceral transplantation
  • Transplant outcomes

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Vianna, R. M., Mangus, R., Fridell, J. A., Kazimi, M., Hollinger, E., & Tector, J. (2008). Initiation of an intestinal transplant program: The indiana experience. Transplantation, 85(12), 1784-1789. https://doi.org/10.1097/TP.0b013e31817889a1

Initiation of an intestinal transplant program : The indiana experience. / Vianna, Rodrigo M.; Mangus, Richard; Fridell, Jonathan A.; Kazimi, Marwan; Hollinger, Edward; Tector, Joseph.

In: Transplantation, Vol. 85, No. 12, 27.06.2008, p. 1784-1789.

Research output: Contribution to journalArticle

Vianna, RM, Mangus, R, Fridell, JA, Kazimi, M, Hollinger, E & Tector, J 2008, 'Initiation of an intestinal transplant program: The indiana experience', Transplantation, vol. 85, no. 12, pp. 1784-1789. https://doi.org/10.1097/TP.0b013e31817889a1
Vianna, Rodrigo M. ; Mangus, Richard ; Fridell, Jonathan A. ; Kazimi, Marwan ; Hollinger, Edward ; Tector, Joseph. / Initiation of an intestinal transplant program : The indiana experience. In: Transplantation. 2008 ; Vol. 85, No. 12. pp. 1784-1789.
@article{402f4c97f2094cf0bcdc5b21bcff3f89,
title = "Initiation of an intestinal transplant program: The indiana experience",
abstract = "INTRODUCTION.: Establishment of a new intestinal transplant (Itx) program in the United States entails significant programmatic costs and a steep learning curve. We report results of the first 4 years of the program at Indiana University. METHODS.: Forty-six intestinal and multivisceral transplants (MVtx) were performed between 2003 and 2007. All organ procurements were performed by our team. Immunosuppression included an induction protocol combined with maintenance tacrolimus monotherapy. Scheduled rejection surveillance was with magnification endoscopy. RESULTS.: Forty-three patients (13 children and 30 adults) received 10 Itx (22{\%}), 5 modified MVtxs (11{\%}), and 31 (MVtx, 67{\%}). Recipient ages ranged from 3 months to 66 years, with median follow-up time of 15 months. Thirty-five patients are currently alive (81{\%}). Patient and graft survival at 30 days was 85{\%}/86{\%} in pediatric and 93{\%}/91{\%} in adult; overall survival was 69{\%}/64{\%} in pediatric and 87{\%}/75{\%} in adult. Thirty patients (69{\%}) experienced episodes of rejection. Multivisceral transplanted patients experienced less episodes of severe rejection (2/31, 6{\%}) when compared with patients with isolated Itx and modified MVtxs. Retransplantation was performed in three patients with nonresponsive severe acute rejection. CONCLUSION.: The Indiana University Intestinal and Multivisceral Transplant program experienced significant early graft loss and mortality among pediatric patients, but not among adults. This discrepancy resolved within 2 years of program initiation. After 4 years, adult and pediatric graft and patient survival statistics are similar to those at other programs.",
keywords = "Intestinal transplantation, Multivisceral transplantation, Transplant outcomes",
author = "Vianna, {Rodrigo M.} and Richard Mangus and Fridell, {Jonathan A.} and Marwan Kazimi and Edward Hollinger and Joseph Tector",
year = "2008",
month = "6",
day = "27",
doi = "10.1097/TP.0b013e31817889a1",
language = "English",
volume = "85",
pages = "1784--1789",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Initiation of an intestinal transplant program

T2 - The indiana experience

AU - Vianna, Rodrigo M.

AU - Mangus, Richard

AU - Fridell, Jonathan A.

AU - Kazimi, Marwan

AU - Hollinger, Edward

AU - Tector, Joseph

PY - 2008/6/27

Y1 - 2008/6/27

N2 - INTRODUCTION.: Establishment of a new intestinal transplant (Itx) program in the United States entails significant programmatic costs and a steep learning curve. We report results of the first 4 years of the program at Indiana University. METHODS.: Forty-six intestinal and multivisceral transplants (MVtx) were performed between 2003 and 2007. All organ procurements were performed by our team. Immunosuppression included an induction protocol combined with maintenance tacrolimus monotherapy. Scheduled rejection surveillance was with magnification endoscopy. RESULTS.: Forty-three patients (13 children and 30 adults) received 10 Itx (22%), 5 modified MVtxs (11%), and 31 (MVtx, 67%). Recipient ages ranged from 3 months to 66 years, with median follow-up time of 15 months. Thirty-five patients are currently alive (81%). Patient and graft survival at 30 days was 85%/86% in pediatric and 93%/91% in adult; overall survival was 69%/64% in pediatric and 87%/75% in adult. Thirty patients (69%) experienced episodes of rejection. Multivisceral transplanted patients experienced less episodes of severe rejection (2/31, 6%) when compared with patients with isolated Itx and modified MVtxs. Retransplantation was performed in three patients with nonresponsive severe acute rejection. CONCLUSION.: The Indiana University Intestinal and Multivisceral Transplant program experienced significant early graft loss and mortality among pediatric patients, but not among adults. This discrepancy resolved within 2 years of program initiation. After 4 years, adult and pediatric graft and patient survival statistics are similar to those at other programs.

AB - INTRODUCTION.: Establishment of a new intestinal transplant (Itx) program in the United States entails significant programmatic costs and a steep learning curve. We report results of the first 4 years of the program at Indiana University. METHODS.: Forty-six intestinal and multivisceral transplants (MVtx) were performed between 2003 and 2007. All organ procurements were performed by our team. Immunosuppression included an induction protocol combined with maintenance tacrolimus monotherapy. Scheduled rejection surveillance was with magnification endoscopy. RESULTS.: Forty-three patients (13 children and 30 adults) received 10 Itx (22%), 5 modified MVtxs (11%), and 31 (MVtx, 67%). Recipient ages ranged from 3 months to 66 years, with median follow-up time of 15 months. Thirty-five patients are currently alive (81%). Patient and graft survival at 30 days was 85%/86% in pediatric and 93%/91% in adult; overall survival was 69%/64% in pediatric and 87%/75% in adult. Thirty patients (69%) experienced episodes of rejection. Multivisceral transplanted patients experienced less episodes of severe rejection (2/31, 6%) when compared with patients with isolated Itx and modified MVtxs. Retransplantation was performed in three patients with nonresponsive severe acute rejection. CONCLUSION.: The Indiana University Intestinal and Multivisceral Transplant program experienced significant early graft loss and mortality among pediatric patients, but not among adults. This discrepancy resolved within 2 years of program initiation. After 4 years, adult and pediatric graft and patient survival statistics are similar to those at other programs.

KW - Intestinal transplantation

KW - Multivisceral transplantation

KW - Transplant outcomes

UR - http://www.scopus.com/inward/record.url?scp=49149115036&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49149115036&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e31817889a1

DO - 10.1097/TP.0b013e31817889a1

M3 - Article

C2 - 18580472

AN - SCOPUS:49149115036

VL - 85

SP - 1784

EP - 1789

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 12

ER -