Grant David, Abu-Elmagd Kareem, Reyes Jorge, Tzakis Andreas, Langnas Alan, Fishbein Thomas, Goulet Olivier, Farmer Douglas
University Health Network, Toronto General Hospital, 200 Elizabeth Street, NCSB 11C-1248, Toronto, ON M5G 2C4, Canada.
Ann Surg. 2005 Apr;241(4):607-13. doi: 10.1097/01.sla.0000157265.85388.a1.
The intestine has been more difficult to transplant than other solid organs. We analyzed registry data to determine the scope and success of intestine transplantation in the current era.
All known intestinal-transplant programs participated. Patient- and graft-survival estimates were obtained using the Kaplan-Meier product limit method and were analyzed with the Wilcoxon statistic.
Sixty-one programs provided data on 989 grafts in 923 patients. Four patients were lost to follow-up. The short-gut syndrome was the most common primary indication for transplantation. Sixty-one percent of the recipients were < or =18 years. Proportionally more combined intestinal and liver transplants were performed in this group. More than 80% of all current survivors had stopped parenteral nutrition and resumed normal daily activities. A multivariate analysis of cases within the last 5 years revealed that transplantation of patients waiting at home, recipient age, antibody induction immune suppression, and center experience with at least 10 cases were associated with improved patient survival. One-year graft survival rates of 81% were achieved in patients who were induced with antithymocyte globulin and maintained on tacrolimus.
Transplantation is an effective therapy for the treatment of patients with end-stage intestine failure who cannot tolerate parenteral nutrition. With newer immune suppressive protocols, 1-year graft and patient survival rates approach the results of liver transplantation. Further improvement in survival are expected with early referral since suitable donor organs are scarce and survival rates are better when patients are well enough to wait at home for their transplant.
肠道移植比其他实体器官移植更具难度。我们分析了登记数据,以确定当前时代肠道移植的范围和成功率。
所有已知的肠道移植项目均参与其中。采用Kaplan-Meier乘积限界法获得患者和移植物生存率估计值,并使用Wilcoxon统计量进行分析。
61个项目提供了923例患者989次移植物的数据。4例患者失访。短肠综合征是最常见的主要移植适应证。61%的受者年龄≤18岁。该组中进行的联合肠道和肝脏移植比例更高。目前所有存活者中,超过80%已停止肠外营养并恢复正常日常活动。对过去5年内的病例进行多因素分析显示,在家等待移植的患者、受者年龄、抗体诱导免疫抑制以及中心至少有10例病例的经验与患者生存率提高相关。接受抗胸腺细胞球蛋白诱导并使用他克莫司维持治疗的患者1年移植物生存率达到81%。
移植是治疗无法耐受肠外营养的终末期肠道衰竭患者的有效疗法。采用更新的免疫抑制方案,1年移植物和患者生存率接近肝脏移植的结果。由于合适的供体器官稀缺,且患者身体状况良好到足以在家等待移植时生存率更高,早期转诊有望进一步提高生存率。