Department of Surgery, Icahn School of Medicine at Mount Sinai, Recanati Miller Transplantation Institute, New York, New York, USA.
Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, Institute for Implementation Science and Population Health, City University of New York, New York, New York, USA.
Am J Transplant. 2020 Dec;20(12):3550-3557. doi: 10.1111/ajt.16065. Epub 2020 Jun 23.
Recent data suggest that frequent endoscopy and biopsy without evidence of graft dysfunction does not appear to confer survival advantage after intestinal transplantation. After abandoning protocol surveillance, endoscopic examination was decreased significantly at our center. These observations led us to question the need for stoma creation in intestinal transplantation. Herein, we report clinical outcomes of intestinal transplantation without stoma, compared to conventional transplant with stoma. Data analysis was limited to adult intestinal transplantation without liver allograft between 2015 and 2018. We compared patient and graft survival, frequency of endoscopic evaluation, episodes of acute rejection, nutritional therapy, and renal function between "Control group (with stoma)," n = 18 grafts in 16 patients and "Study group (without stoma)," n = 16 grafts in 15 patients. Overall outcome was similar between the 2 groups with respect to graft and patient survival, episodes of acute rejection, and its response to treatment. Nutritional outcomes were similar in both groups. Fewer antidiarrheal medications were required in the study group, but this did not translate into demonstrable gains in preservation of renal function, despite an apparent trend to improvement. Intestinal transplantation without stoma appears to be an acceptable practice model without obvious adverse impact on outcome.
最近的数据表明，在肠移植后，频繁进行内镜检查和活检而没有移植物功能障碍的证据，似乎并不能带来生存优势。在放弃方案监测后，我们中心的内镜检查显著减少。这些观察结果使我们质疑肠移植中是否需要造口。在此，我们报告了无造口的肠移植与传统带造口的肠移植的临床结果。数据分析仅限于 2015 年至 2018 年期间进行的无肝供体的成人肠移植。我们比较了“对照组（带造口）”，n = 16 例患者中的 18 个移植物和“研究组（无造口）”，n = 15 例患者中的 16 个移植物的患者和移植物存活率、内镜评估频率、急性排斥反应发作、营养治疗和肾功能。两组在移植物和患者存活率、急性排斥反应发作及其对治疗的反应方面的总体结果相似。两组的营养结局相似。研究组需要的止泻药物较少，但这并没有转化为肾功能保存的明显获益，尽管有明显的改善趋势。无造口的肠移植似乎是一种可接受的实践模式，对结果没有明显的不利影响。
