Trevizol A P, David A I, Yamashita E T, Pecora R A, D'Albuquerque L A
Santa Casa Medical School, São Paulo, Brazil.
Transplant Proc. 2013 Apr;45(3):1133-6. doi: 10.1016/j.transproceed.2013.03.007.
Intestinal/multivisceral transplantation (IT/MVT) is the gold standard treatment for patients with intestinal failure and complications related to total parenteral nutrition, gastrointestinal inoperable indolent tumors, or diffuse portal trombosis. Currently, the reported 1-year patient survival rate is around 80%, similar to other solid organ abdominal transplantations. Unfortunately, the patient survival decreases after the first year with the 5-year rate not close to 70% yet. Acute cellular rejection is the main cause of graft loss. Its early diagnosis may make it possible to improve survival of retransplantations.
To analyze the reported results published in the last 5 years by leading transplant centers to evaluate IT/MVT retransplantation results.
We performed a literature review using PubMed focusing on multivisceral and intestinal retransplantation in articles published between 2006 and 2012. In relation to the first transplantation, we analyzed demographics, imunosuppression, rejection, infection as well as graft and patient survival rates.
Two centers reported results on intestinal and multivisceral retransplantations. Mazariegos et al reported their experience with 15 intestinal retransplantations in 14 pediatric recipients. Four patients died from posttransplant lymphoperliferative disease, severe acute cellular rejection, fungal sepsis, or bleeding from a pseudoaneurysm at a mean time of 5.7 months post-transplantation. Total parenteral nutrition was weaned at a median time of 32 days. Abu-Elmaged et al reported 47 cases with a 5-year survival of 47% for all retransplant modalities. Retransplantation with liver-contained visceral allograft achieved a 5-year survival rate of 61% compared with 16% for liver-free visceral grafts.
Despite those huge improvements, some transplanted patients develop severe acute cellular rejection, culminating in graft loss and retransplantation. Repots on multivisceral and intestinal retransplantation outcomes suggest that it is a viable procedure with appropriate patient survival after primary graft loss.
肠/多脏器移植（IT/MVT）是治疗肠衰竭以及与全胃肠外营养、胃肠道无法手术切除的惰性肿瘤或弥漫性门静脉血栓形成相关并发症患者的金标准治疗方法。目前，报道的1年患者生存率约为80%，与其他腹部实体器官移植相似。不幸的是，1年后患者生存率下降，5年生存率尚未接近70%。急性细胞排斥反应是移植物丢失的主要原因。其早期诊断可能使再次移植的生存率提高成为可能。
分析领先移植中心在过去5年发表的报告结果，以评估IT/MVT再次移植的结果。
我们使用PubMed进行了文献综述，重点关注2006年至2012年发表的文章中的多脏器和肠再次移植。关于首次移植，我们分析了人口统计学、免疫抑制、排斥反应、感染以及移植物和患者生存率。
两个中心报告了肠和多脏器再次移植的结果。马扎里戈斯等人报告了他们对14名儿科受者进行15例肠再次移植的经验。4例患者在移植后平均5.7个月死于移植后淋巴细胞增生性疾病、严重急性细胞排斥反应、真菌败血症或假性动脉瘤出血。全胃肠外营养在中位时间32天撤停。阿布 - 埃尔马吉德等人报告了47例病例，所有再次移植方式的5年生存率为47%。包含肝脏的内脏同种异体移植物再次移植的5年生存率为61%，而不包含肝脏的内脏移植物为16%。
尽管有这些巨大进步，但一些移植患者仍会发生严重急性细胞排斥反应，最终导致移植物丢失和再次移植。关于多脏器和肠再次移植结果的报告表明，这是一种可行的手术，在原发性移植物丢失后患者有适当的生存率。
