Intestinal transplantation in composite visceral grafts or alone

S. Todo, A. G. Tzakis, K. Abu-Elmagd, J. Reyes, K. Nakamura, A. Casavilla, R. Selby, B. M. Nour, H. Wright, J. J. Fung, A. J. Demetris, D. H. Van Thiel, T. E. Starzl, R. W. Busuttil, F. T. Rapaport, L. O. Vasconez, J. C. Thompson, B. W. Shaw

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Abstract

Under FK 506-based immunosuppression, the entire cadaver small bowel except for a few proximal and distal centimeters was translated to 17 randomly matched patients, of whom two had antigraft cytotoxic antibodies (positive cross-match). Eight patients received the intestine only, eight had intestine in continuity with the liver, and one received a full multivisceral graft that included the liver, stomach, and pancreas. One liver-intestine recipient died after an intestinal anastomotic leak, sepsis, and graft- versus-host disease. The other 16 patients are alive after 1 to 23 months, in one case after chronic rejection, graft removal, and retransplantation. Twelve of the patients have been liberated from total parenteral nutrition, including all whose transplantation was 2 months or longer ago. The grafts have supported good nutrition, and in children, have allowed growth and weight gain. Management of these patients has been difficult and often complicated, but the end result has been satisfactory in most cases, justifying further clinical trials. The convalescence of the eight patients receiving intestine only has been faster and more trouble free than after liver-intestine or multivisceral transplantation, with no greater difficulty in the control of rejection.

Original languageEnglish
Pages (from-to)223-234
Number of pages12
JournalAnnals of surgery
Volume216
Issue number3
DOIs
Publication statusPublished - 1 Jan 1992

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ASJC Scopus subject areas

  • Surgery

Cite this

Todo, S., Tzakis, A. G., Abu-Elmagd, K., Reyes, J., Nakamura, K., Casavilla, A., Selby, R., Nour, B. M., Wright, H., Fung, J. J., Demetris, A. J., Van Thiel, D. H., Starzl, T. E., Busuttil, R. W., Rapaport, F. T., Vasconez, L. O., Thompson, J. C., & Shaw, B. W. (1992). Intestinal transplantation in composite visceral grafts or alone. Annals of surgery, 216(3), 223-234. https://doi.org/10.1097/00000658-199209000-00002