Lauro A, Dazzi A, Ercolani G, Cescon M, D'Errico A, Di Simone M, Grazi G L, Vivarelli M, Varotti G, De Ruvo N, Masetti M, Cautero N, Di Benedetto F, Siniscalchi A, Begliomini B, Lazzarotto T, Faenza S, Pironi L, Pinna A D
UO Chirurgia dei Trapianti di Fegato e Multiorgano, University of Bologna, Policlinico S. Orsola-Malpighi, PAD 25, Via Massarenti 9, 40138 Bologna, Italy.
Transplant Proc. 2006 Jul-Aug;38(6):1696-8. doi: 10.1016/j.transproceed.2006.05.021.
We report our experience with intestinal and multivisceral transplantation in Italy.
We performed 23 adult isolated intestinal transplants and seven multivisceral ones, three with liver, between December 2000 and June 2005. Indications for transplantation were loss of venous access (n = 14), recurrent sepsis (n = 10), and electrolyte-fluid imbalance (n = 6), 14 of whom also presented with total parenteral nutrition (TPN)-related liver dysfunction. Immunosuppression was based on induction agents like daclizumab (followed by tacrolimus and steroids) in the first period; alemtuzumab or thymoglobulin (with tacrolimus) in a second period after 2002.
The mean follow-up was 742 +/- 550 days. Three-year patient actuarial survival rate was 88% for intestinal transplants and 42% for multivisceral (P = .015). Three-year graft actuarial survival rate was 73% for intestinal patients and 42.8% for multivisceral (P = .1). Graft loss was mainly due to rejection (57%). Complications were mainly represented by bacterial infections (92% of patients), relaparotomies (82%), and rejections (72%). Full bowel function without any parenteral nutrition or intravenous fluid support was achieved in 60% of recipients with functioning bowel including 95% on a regular diet. One patient underwent abdominal wall transplantation as well.
Intestinal transplantation has achieved high rates of patient and graft survival with even longer follow-up. Early referral of patients, especially in cases of TPN-liver disease, is mandatory to obtain good outcomes and avoid high mortality rates on the transplant waiting list. Immunosuppressive management remains the key factor to increase the success rate.
我们报告在意大利进行肠移植和多脏器移植的经验。
2000年12月至2005年6月期间，我们进行了23例成人孤立性肠移植和7例多脏器移植，其中3例联合肝脏移植。移植指征为静脉通路丧失（n = 14）、反复败血症（n = 10）和电解质-液体失衡（n = 6），其中14例还伴有全胃肠外营养（TPN）相关肝功能障碍。免疫抑制在第一阶段基于诱导剂如达利珠单抗（随后使用他克莫司和类固醇）；2002年后的第二阶段使用阿仑单抗或抗胸腺细胞球蛋白（联合他克莫司）。
平均随访时间为742±550天。肠移植患者的三年实际生存率为88%，多脏器移植患者为42%（P = 0.015）。肠移植患者的三年移植物实际生存率为73%，多脏器移植患者为42.8%（P = 0.1）。移植物丢失主要由于排斥反应（57%）。并发症主要表现为细菌感染（92%的患者）、再次剖腹手术（82%）和排斥反应（72%）。60%具有功能的肠道受者实现了完全肠道功能，无需任何胃肠外营养或静脉液体支持，其中95%能够正常饮食。1例患者还接受了腹壁移植。
随着更长时间的随访，肠移植已实现了较高的患者和移植物生存率。必须尽早转诊患者，尤其是TPN相关肝病患者，以获得良好的结果并避免移植等待名单上的高死亡率。免疫抑制管理仍然是提高成功率的关键因素。
