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Clinical intestinal transplantation: New perspectives and immunologic considerations

Abu-Elmagd, K and Reyes, J and Todo, S and Rao, A and Lee, R and Irish, W and Furukawa, H and Bueno, J and McMichael, J and Fawzy, AT and Murase, N and Demetris, J and Rakela, J and Fung, JJ and Starzl, TE (1998) Clinical intestinal transplantation: New perspectives and immunologic considerations. Journal of the American College of Surgeons, 186 (5). 512 - 527. ISSN 1072-7515

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Abstract

Background: Although tacrolimus-based immunosuppression has made intestinal transplantation feasible, the risk of the requisite chronic high- dose treatment has inhibited the widespread use of these procedures. We have examined our 1990-1997 experience to determine whether immunomodulatory strategies to improve outlook could be added to drug treatment. Study Design: Ninety-eight consecutive patients (59 children, 39 adults) with a panoply of indications received 104 allografts under tacrolimus-based immunosuppression: intestine only (n = 37); liver and intestine (n = 50); or multivisceral (n = 17). Of the last 42 patients, 20 received unmodified adjunct donor bone marrow cells; the other 22 were contemporaneous control patients. Results: With a mean followup of 32 ± 26 months (range, 1-86 months), 12 recipients (3 intestine only, 9 composite grafts) are alive with good nutrition beyond the 5-year milestone. Forty-seven (48%) of the total group survive bearing grafts that provide full (91%) or partial (9%) nutrition. Actuarial patient survival at 1 and 5 years (72% and 48%, respectively) was similar with isolated intestinal and composite graft recipients, but the loss rate of grafts from rejection was highest with intestine alone. The best results were in patients between 2 and 18 years of age (68% at 5 years). Adjunct bone marrow did not significantly affect the incidence of graft rejection, B-cell lymphoma, or the rate or severity of graft-versus-host disease. Conclusions: These results demonstrate that longterm rehabilitation similar to that with the other kinds of organ allografts is achievable with all three kinds of intestinal transplant procedures, that the morbidity and mortality is still too high for their widespread application, and that the liver is significantly but marginally protective of concomitantly engrafted intestine. Although none of the endpoints were markedly altered by donor leukocyte augmentation (and chimerism) with bone marrow, establishment of the safety of this adjunct procedure opens the way to further immune modulation strategies that can be added to the augmentation protocol.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Abu-Elmagd, K
Reyes, J
Todo, S
Rao, A
Lee, R
Irish, W
Furukawa, H
Bueno, J
McMichael, J
Fawzy, AT
Murase, N
Demetris, J
Rakela, J
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 26 May 1998
Date Type: Publication
Journal or Publication Title: Journal of the American College of Surgeons
Volume: 186
Number: 5
Page Range: 512 - 527
DOI or Unique Handle: 10.1016/s1072-7515(98)00083-0
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 1072-7515
Other ID: uls-drl:31735062127281, Starzl CV No. 2007
Date Deposited: 08 Apr 2010 17:34
Last Modified: 13 Oct 2017 20:55
URI: http://d-scholarship.pitt.edu/id/eprint/5393

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