Three years clinical experience with intestinal transplantation

K. Abu-Elmagd, S. Todo, A. Tzakis, J. Reyes, Bakr Nour, H. Furukawa, J. J. Fung, A. Demetris, T. E. Starzl

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. STUDY DESIGN: Forty-three consecutive patients with short bowel syndrome, intestinal insufficiency, or malignant tumors with or without associated liver disease, were given intestinal (n=15), hepatic and intestinal (n=21), or multivisceral allografts that contained four or more organs (n=7). Treatment was with FK 506 based immunosuppression. The ascending and right transverse colon were included with the small intestine in 13 of the 43 grafts, almost evenly distributed between the three groups. RESULTS: After six to 39 months, 30 of the 43 patients are alive, 29 bearing grafts. The most rapid convalescence and resumption of diet, as well as the highest three month patient survival (100 percent) and graft survival (88 percent) were with the isolated intestinal procedure. However, this advantage was slowly eroded during the first two postoperative years, in part because the isolated intestine was more prone to rejection. By the end of this time, the best survival rate (86 percent) was with the multivisceral procedure. With all three operations, most of the patients were able to resume diet and discontinue parenteral alimentation, and in the best instances, the quality of life approached normal. However, the surveillance and intensity of care required for these patients for the first year, and in most instances thereafter, was very high, being far more than required for patients having transplants of the liver, kidney or heart. CONCLUSIONS: Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation.

Original languageEnglish
Pages (from-to)385-400
Number of pages16
JournalJournal of the American College of Surgeons
Volume179
Issue number4
Publication statusPublished - 1994
Externally publishedYes

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Transplantation
Transplants
Tacrolimus
Graft Survival
Diet
Short Bowel Syndrome
Transverse Colon
Autologous Transplantation
Liver
Immunosuppressive Agents
Bone Marrow Transplantation
Liver Transplantation
Immunosuppression
Small Intestine
Intestines
Allografts
Liver Diseases
Patient Care
Survival Rate
Quality of Life

ASJC Scopus subject areas

  • Surgery

Cite this

Abu-Elmagd, K., Todo, S., Tzakis, A., Reyes, J., Nour, B., Furukawa, H., ... Starzl, T. E. (1994). Three years clinical experience with intestinal transplantation. Journal of the American College of Surgeons, 179(4), 385-400.

Three years clinical experience with intestinal transplantation. / Abu-Elmagd, K.; Todo, S.; Tzakis, A.; Reyes, J.; Nour, Bakr; Furukawa, H.; Fung, J. J.; Demetris, A.; Starzl, T. E.

In: Journal of the American College of Surgeons, Vol. 179, No. 4, 1994, p. 385-400.

Research output: Contribution to journalArticle

Abu-Elmagd, K, Todo, S, Tzakis, A, Reyes, J, Nour, B, Furukawa, H, Fung, JJ, Demetris, A & Starzl, TE 1994, 'Three years clinical experience with intestinal transplantation', Journal of the American College of Surgeons, vol. 179, no. 4, pp. 385-400.
Abu-Elmagd K, Todo S, Tzakis A, Reyes J, Nour B, Furukawa H et al. Three years clinical experience with intestinal transplantation. Journal of the American College of Surgeons. 1994;179(4):385-400.
Abu-Elmagd, K. ; Todo, S. ; Tzakis, A. ; Reyes, J. ; Nour, Bakr ; Furukawa, H. ; Fung, J. J. ; Demetris, A. ; Starzl, T. E. / Three years clinical experience with intestinal transplantation. In: Journal of the American College of Surgeons. 1994 ; Vol. 179, No. 4. pp. 385-400.
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AU - Todo, S.

AU - Tzakis, A.

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AU - Furukawa, H.

AU - Fung, J. J.

AU - Demetris, A.

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N2 - BACKGROUND: After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. STUDY DESIGN: Forty-three consecutive patients with short bowel syndrome, intestinal insufficiency, or malignant tumors with or without associated liver disease, were given intestinal (n=15), hepatic and intestinal (n=21), or multivisceral allografts that contained four or more organs (n=7). Treatment was with FK 506 based immunosuppression. The ascending and right transverse colon were included with the small intestine in 13 of the 43 grafts, almost evenly distributed between the three groups. RESULTS: After six to 39 months, 30 of the 43 patients are alive, 29 bearing grafts. The most rapid convalescence and resumption of diet, as well as the highest three month patient survival (100 percent) and graft survival (88 percent) were with the isolated intestinal procedure. However, this advantage was slowly eroded during the first two postoperative years, in part because the isolated intestine was more prone to rejection. By the end of this time, the best survival rate (86 percent) was with the multivisceral procedure. With all three operations, most of the patients were able to resume diet and discontinue parenteral alimentation, and in the best instances, the quality of life approached normal. However, the surveillance and intensity of care required for these patients for the first year, and in most instances thereafter, was very high, being far more than required for patients having transplants of the liver, kidney or heart. CONCLUSIONS: Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation.

AB - BACKGROUND: After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. STUDY DESIGN: Forty-three consecutive patients with short bowel syndrome, intestinal insufficiency, or malignant tumors with or without associated liver disease, were given intestinal (n=15), hepatic and intestinal (n=21), or multivisceral allografts that contained four or more organs (n=7). Treatment was with FK 506 based immunosuppression. The ascending and right transverse colon were included with the small intestine in 13 of the 43 grafts, almost evenly distributed between the three groups. RESULTS: After six to 39 months, 30 of the 43 patients are alive, 29 bearing grafts. The most rapid convalescence and resumption of diet, as well as the highest three month patient survival (100 percent) and graft survival (88 percent) were with the isolated intestinal procedure. However, this advantage was slowly eroded during the first two postoperative years, in part because the isolated intestine was more prone to rejection. By the end of this time, the best survival rate (86 percent) was with the multivisceral procedure. With all three operations, most of the patients were able to resume diet and discontinue parenteral alimentation, and in the best instances, the quality of life approached normal. However, the surveillance and intensity of care required for these patients for the first year, and in most instances thereafter, was very high, being far more than required for patients having transplants of the liver, kidney or heart. CONCLUSIONS: Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation.

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