Five Hundred Intestinal and Multivisceral Transplantations at a Single Center Major Advances With New Challenges

Objective: To assess the evolution of visceral transplantation In the milieu Of surgical technical modifications. new immunosuppressive protocols, and other management strategies Summary Background Data: With the clinical feasibility of Intestinal and multivisceral transplantation in 1990. multifaceted innovative tactics Were required to improve outcome and Increase procedural practicality Methods: Divided into 3 eras. 453 patients received 500 visceral transplants The primary used immunosuppression Was tacrolimus-steroid-only during Era 1 (5/90-5/94). adjunct induction with multiple drug therapy (hiring Era 11 (1/95-6/01). and recipient pretreatment with tacrolimus monotherapy during Era III (7/01-11/08) During Era II/III, donor bone marrow was given (n =- 79) intestine was ex vivo Irradiated (n = 44), and Epstein-Barr-Virus (EBV)/cytomegalovirus (CMV) leads were monitored Results: Actuarial patient survival was 85% at 1-year. 61% at (5-years. 42% at 10-years. and 35% at 15-years with respective graft survival of 80%. 50%. 33%. and 29%. With a 10% retransplantation rate. second/third graft survival was 69% at 1-year and 47% at 5-years The best outcome was with intestine-liver allografts Era III rabbit antithymocyte globulin or alemtuzumab pretreatment-based strategy was associated with significant (P < 0.001) improvement in outcome with 1- and 5-year patient survival of 92% and 70% Conclusion: Survival has greatly improved over time as management strategies evolved The current results clearly justify elevating the procedure level to that of other abdominal organs With the privilege to permanently reside in a respected place in the surgical armamentarum U III Meanwhile. innovative tactics are still required to conquer long long-term hazards of chronic rejection of liver-free allografts and infection of multivisceral recipients.