Nagai Shunji, Mangus Richard S, Anderson Eve, Ekser Burcin, Kubal Chandrashekhar A, Fridell Jonathan A, Tector A Joseph
1 Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. 2 Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI.
Transplantation. 2017 Feb;101(2):411-420. doi: 10.1097/TP.0000000000001102.
Intestinal graft dysfunction is sometimes irreversible and requires allograft enterectomy with or without retransplantation. There is no comprehensive assessment of allograft enterectomy regarding indications and outcomes. The aim of this study was to evaluate management of patients with intestinal graft failure with special reference to indications and outcomes of allograft enterectomy and the procedure's validity as a bridge to retransplantation.
Graft and patient survivals, reason for graft failure, and rejection episodes were evaluated in 221 intestinal recipients (primary transplantation [n = 201], retransplantation [n = 20]). Indications, surgical factors, and outcomes of allograft enterectomy were investigated.
Reasons for isolated enterectomy included systemic infection in 11, gastrointestinal bleeding in 1, and severe electrolyte imbalance in 1, all of which were associated with rejection. One isolated intestinal transplantation patient underwent isolated enterectomy due to cytomegalovirus enteritis. One multivisceral transplantation patient underwent isolated allograft enterectomy due to bowel necrosis. Of these 15 patients, 3 died from persistent infection postoperatively, whereas 8 underwent retransplantation with median interval of 74 days (42-252 days). Allosensitization occurred between isolated enterectomy and retransplantation in 2, one of whom lost the second graft due to rejection. Simultaneous allograft enterectomy and retransplantation was performed in 3 isolated intestinal transplantation and 9 multivisceral transplantation patients. Patient survival after retransplantation was similar between patients who underwent isolated allograft enterectomy and those who did simultaneous enterectomy with retransplantation (P = 0.82).
In cases of irreversible intestinal graft dysfunction, isolated allograft enterectomy successfully provides recovery from comorbidities as a lifesaving procedure and does not compromise outcomes of retransplantation.
肠道移植功能障碍有时是不可逆的，需要进行同种异体肠切除术，可选择或不选择再次移植。目前尚无关于同种异体肠切除术的适应证和结局的全面评估。本研究的目的是评估肠道移植失败患者的管理，特别关注同种异体肠切除术的适应证和结局，以及该手术作为再次移植桥梁的有效性。
对221例肠道移植受者（首次移植[n = 201]，再次移植[n = 20]）的移植物和患者生存率、移植失败原因及排斥反应发作情况进行评估。调查同种异体肠切除术的适应证、手术因素及结局。
单纯肠切除术的原因包括11例全身性感染、1例胃肠道出血和1例严重电解质紊乱，所有这些均与排斥反应相关。1例单纯肠道移植患者因巨细胞病毒肠炎接受单纯肠切除术。1例多脏器移植患者因肠坏死接受单纯同种异体肠切除术。这15例患者中，3例术后死于持续性感染，而8例接受了再次移植，中位间隔时间为74天（42 - 252天）。2例在单纯肠切除术和再次移植之间发生了同种异体致敏，其中1例因排斥反应失去了第二个移植物。3例单纯肠道移植患者和9例多脏器移植患者同时进行了同种异体肠切除术和再次移植。接受单纯同种异体肠切除术的患者与同时进行肠切除术和再次移植的患者再次移植后的患者生存率相似（P = 0.82）。
在不可逆的肠道移植功能障碍病例中，单纯同种异体肠切除术作为一种挽救生命的手术成功地使合并症得到缓解，且不影响再次移植的结局。
