Intestine and Multivisceral Transplantation in the United States: A Report of 20-year National Registry Data (1990-2009).

Cai J.

Clinical Transplants 2009, Chapter 6

Abstract

A total of 1,859 intestinal transplants was reported to UNOS during the past 20 years (1,822 deceased, and 37 living donors). Forty-three US transplant centers reported at least one intestinal transplant, among them, Jackson Memorial Hospital, Nebraska Medical Center and University of Pittsburgh Medical Center were the 3 largest centers, each performing more than 300 cases. The University of Illinois Medical Center performed the most (N = 24) living donor intestinal transplants. The one-, five-, and ten-year graft survival rates of all recipients are 71%, 45%, and 32%. The longest surviving adult intestine transplant is 19 years posttransplant and the longest surviving pediatric transplant is 18 yrs. Both were simultaneous intestine and liver transplants from deceased donors. The first living-donor intestine transplant was reported to UNOS in 1995. The patient received an intestine-alone transplant which functioned for 501 days. The longest surviving living donor intestine transplant is still functioning after 11 years. Among transplants that included the intestine, 37% were intestine-alone transplants, 30% included intestineLiverPancreas, and 24% were intestineLiver. One-, 5-, and 10-year graft survival rates of intestine-alone recipients were 80%, 44% and 26%; while those for IntestineLiver and intestineLiverPancreas, were, 62%, 45%, 36%, and 69%, 48%, 33%, respectively. HLA mismatches seemed to have no effect on graft survival for primary intestinal graft recipients, but the most poorly matched (5-6-HLA antigen mismatches) regraft recipients had notably lower graft survival rates. Patients who received ABO blood type compatible intestinal grafts from an \O\" donor had a significantly lower graft survival than AB recipients of an A or B donor or those who received ABO identical transplants. Only 4 ABO incompatible intestinal transplants have been reported and all of them have failed. The first ABO incompatible transplant in the US was performed in 1990 and the graft survived for 7 days. The longest survival of an ABO incompatible transplant was 3.5 years. Ischemic time of intestine