Abu-Elmagd K, Reyes J, Bond G, Mazariegos G, Wu T, Murase N, Sindhi R, Martin D, Colangelo J, Zak M, Janson D, Ezzelarab M, Dvorchik I, Parizhskaya M, Deutsch M, Demetris A, Fung J, Starzl T E
Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Surg. 2001 Sep;234(3):404-16; discussion 416-7. doi: 10.1097/00000658-200109000-00014.
To assess the long-term efficacy of intestinal transplantation under tacrolimus-based immunosuppression and the therapeutic benefit of newly developed adjunct immunosuppressants and management strategies.
With the advent of tacrolimus in 1990, transplantation of the intestine began to emerge as therapy for intestinal failure. However, a high risk of rejection, with the consequent need for acute and chronic high-dose immunosuppression, has inhibited its widespread application.
During an 11-year period, divided into two segments by a 1-year moratorium in 1994, 155 patients received 165 intestinal allografts under immunosuppression based on tacrolimus and prednisone: 65 intestine alone, 75 liver and intestine, and 25 multivisceral. For the transplantations since the moratorium (n = 99), an adjunct immunosuppressant (cyclophosphamide or daclizumab) was used for 74 transplantations, adjunct donor bone marrow was given in 39, and the intestine of 11 allografts was irradiated with a single dose of 750 cGy.
The actuarial survival rate for the total population was 75% at 1 year, 54% at 5 years, and 42% at 10 years. Recipients of liver plus intestine had the best long-term prognosis and the lowest risk of graft loss from rejection (P =.001). Since 1994, survival rates have improved. Techniques for early detection of Epstein-Barr and cytomegaloviral infections, bone marrow augmentation, the adjunct use of the interleukin-2 antagonist daclizumab, and most recently allograft irradiation may have contributed to the better results.
The survival rates after intestinal transplantation have cumulatively improved during the past decade. With the management strategies currently under evaluation, intestinal transplant procedures have the potential to become the standard of care for patients with end-stage intestinal failure.
评估以他克莫司为基础的免疫抑制方案下肠道移植的长期疗效，以及新开发的辅助免疫抑制剂和管理策略的治疗益处。
随着1990年他克莫司的问世，肠道移植开始作为治疗肠衰竭的方法出现。然而，排斥反应的高风险以及随之而来的急性和慢性高剂量免疫抑制需求，阻碍了其广泛应用。
在11年期间，1994年有1年的暂停期，分为两个阶段，155例患者在以他克莫司和泼尼松为基础的免疫抑制下接受了165次肠道同种异体移植：单纯肠道移植65例，肝肠联合移植75例以及多脏器移植25例。对于暂停期后的移植（n = 99），74例移植使用了辅助免疫抑制剂（环磷酰胺或达利珠单抗），39例给予了辅助供体骨髓，11例同种异体移植的肠道接受了单次750 cGy的照射。
总体人群的精算生存率1年时为75%，5年时为54%，10年时为42%。肝肠联合移植受者的长期预后最佳，因排斥反应导致移植物丢失的风险最低（P = 0.001）。自1994年以来，生存率有所提高。早期检测爱泼斯坦-巴尔病毒和巨细胞病毒感染的技术、骨髓强化、白细胞介素-2拮抗剂达利珠单抗的辅助使用以及最近的同种异体移植照射可能促成了更好的结果。
在过去十年中，肠道移植后的生存率累计有所提高。采用目前正在评估的管理策略，肠道移植手术有可能成为终末期肠衰竭患者的标准治疗方法。
