Vianna Rodrigo M, Mangus Richard S, Fridell Jonathan A, Kazimi Marwan, Hollinger Edward, Tector Joseph
Department of Surgery, Transplant Section, Indiana University School of Medicine, Indianapolis, Indiana 46202-5250, USA.
Transplantation. 2008 Jun 27;85(12):1784-90. doi: 10.1097/TP.0b013e31817889a1.
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.
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.
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.
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.
在美国建立一个新的肠道移植（Itx）项目需要巨大的项目成本和艰难的学习过程。我们报告了印第安纳大学该项目前4年的结果。
2003年至2007年间进行了46例肠道和多脏器移植（MVtx）。所有器官获取均由我们的团队完成。免疫抑制包括诱导方案联合维持性他克莫司单药治疗。定期通过放大内镜进行排斥反应监测。
43例患者（13名儿童和30名成人）接受了10例Itx（22%）、5例改良MVtx（11%）和31例MVtx（67%）。受者年龄从3个月到66岁不等，中位随访时间为15个月。目前35例患者存活（81%）。儿童患者30天的患者和移植物存活率分别为85%/86%，成人患者为93%/91%；总体存活率儿童患者为69%/64%，成人患者为87%/75%。30例患者（69%）经历了排斥反应发作。与单纯Itx和改良MVtx患者相比，多脏器移植患者发生严重排斥反应的次数较少（2/31，6%）。3例严重急性排斥反应无反应的患者接受了再次移植。
印第安纳大学肠道和多脏器移植项目在儿科患者中早期移植物丢失和死亡率较高，但在成人患者中并非如此。这种差异在项目启动后的2年内得到解决。4年后，成人和儿科的移植物及患者存活统计数据与其他项目相似。
