Clinical experience of small bowel/multivisceral transplantation at the University of Miami

Some patients with intestinal failure have life-threatening total parenteral nutrition (TPN) complications. Intestinal transplantation is the lifesaving alternative for these patients. We reviewed 95 consecutive intestinal transplants performed between December 1994 and November 2000 at the University of Miami. Fifty-four cases were pediatric and 41 cases were adult. Forty-nine patients were men and 46 women. The causes of intestinal failure were mesenteric thrombosis (n = 12), necrotizing enterocolitis (n = 11), gastroschisis (n = 11), voluvulus (n = 9), desmoid tumor (n = 8), intestinal atresia (n = 6), trauma (n = 5), Hirschsprung's disease (n = 5), Crohn's disease (n = 5), pseudoobstruction (n = 4), and other (n = 19). All patients had TPN-related complications, and 67 patients had liver failure. Isolated intestinal transplantation was performed in 27 cases. Liver and intestinal transplantation was performed in 28 cases. Multivisceral transplantation was performed in 40 cases. Mean cold ischemic time was 480 12.3 min. The 1-year patient and graft survival rates of isolated intestinal transplantation since 1998 were 84% and 72%, respectively. Since 1998, we have been using a zoom videoendoscope and induction with daclizumab. The 1-year patient and graft survivals of isolated intestinal transplants before 1998 were 75% and 68%, respectively. The 1-year patient and graft survival rates of liver and intestinal transplantation were 40% and 37%, respectively. The 1-year patient and graft survival rates of multivisceral transplantation were 48% and 40%, respectively. The causes of death were sepsis after rejection (n 14). respiratory failure (n = 8), sepsis (n = 6), multiple organ failure (n 4), arterial graft infection (n = 3), aspergillosis (n = 2), post transplant lymphoproliferative disorders (n = 2), intracranial bleeding (n = 2), fungemia (n = 1), chronic rejection (n = 1), graft-versus-host disease (n = 1), necrotizing enterocolitis (n = 1), pancreatitis (n = 1), pulmonary embolism (n = 1), and viral encephalitis (n = 1). Intestinal transplantation provided a lifesaving alternative for patients with intestinal failure. Patient and graft survival rates following isolated intestinal transplantation were better than those after liver-intestinal transplantation and multivisceral transplantation. The prognosis is better when the transplant is performed prior to the onset of liver failure.