J.Jpn. Surg. Soc.. 97(11): 1003-1009, 1996

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Feature topic

CLINICAL INTESTINAL TRANSPLANTATION AT THE UNIVERSITY OF PITTSUBRGH : AN UPDATE

From May 1990 until August 1996, 87 patients received 92 intestinal transplantation, including an isolated graft (n＝33), combined liver and intestinal grafts (n＝41), and abdominal multivisceral grafts (n＝13). There were 52 children (mean age 3.3 years) and 35 adult patients (mean age 32.6 years). Of these, 29 patients received the colon as a composite of the intestinal graft, and ll recent patients were given unmodified donor bone marrow cells simultaneously. Postoperative immunosuppression was with Tacrolimus and low-dose steroids, to which either azathioprine, mycophenolate, or cyclophasphamide was added supplementarily.
One-, three-, and five-year patient and graft survival was 73％ and 64％, 44％ and 36％, and 444％ and 36％, respectively. There was no statistical difference in patient and graft survival after different types of intestinal transplantation. Although overall patient and graft survival did not differ between pediatric patients and adult recipients, isolated graft survival children was higher than that of adult recipients (57％ versus 11％ at three years). Transplantation of the grafts from CMV seropositive donors and the inclusion of the colon in the intestinal graft worsened the survival in adult recipients, but not in children. The influence of simultaneous bone marrow transplantation on the outcome is undetermined due to the short follow-up period.
Intestinal transplantation has become feasible, but still requires improved immunosuppression and graft dysmotility management to be a clinical practice.

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