Center experience and Outcome of Intestinal Transplantation.

Abstract

Aim: An association between center experience and post-transplant outcomes after intestinal transplant has not been fully discussed. According to the report from A2ALL, the center experience of performing greater than 20 cases of living liver donor transplant was associated with a significantly lower risk of graft failure. The aim of this study was to investigate intestinal graft outcomes and post-transplant complications by focusing on the impact of center experience. Methods: A total of 30 intestinal and multivisceral transplants from 2010 to 2017 were evaluated. The first 20 cases and recent 10 cases were classified into the early and late experience groups (Groups 1 and 2), respectively. Graft survival, incidence of graft rejection, and post-transplant complications were compared between these two groups. Post-transplant surgical complications were classified based on the Clavien classification. Immunosuppression protocol was same in these two groups; induction with anti-thymocyte globulin (r-ATG, 2 mg/kg, 3 doses) and rituximab (150 mg/m2, one dose), Maintenance immunosuppression regimen included tacrolimus and prednisolone. Patients who had a positive crossmatch at transplant received 5 doses of r-ATG (10mg/kg in total). Results: There was no difference in terms of intestinal graft type; liver excluded graft for 65% and 70%, liver included graft for 35% and 30% in Groups 1 and 2, respectively (p=0.72). Positive crossmatch cases were 25% and 20% in Groups 1 and 2, respectively (p=1.0). One year graft survival was 60% and 89% in Groups 1 and 2, respectively (p=0.13). There were 5 cases of early post-transplant mortality (within 30 days) in Group 1 (25%), whereas no early post-transplant mortality was observed in Group 2. Grade IV complication was observed in 4 patients (20%) in Group 1, whereas no patient developed it in Group 2. Graft rejection requiring treatments occurred in 8 (40%) and 5 (50%) in Groups 1 and 2, respectively. Graft was lost due to rejection in 3 of these 8 in Group 1, whereas no graft loss due to rejection in Group 2.FigureConclusion: A learning curve was identified in our intestinal transplant experience. Graft failure risk, incidence of serious post-transplant complication, and rejection leading to graft loss may decrease after the first 20 intestinal transplant procedures, which are probably associated with stable surgical techniques, increased anesthesia expertise, and sophisticated post-transplant management. Reference: 1. Olthoff KM. Outcomes of 385 Adult-to-Adult Living Donor Liver Transplant Recipients A Report From the A2ALL Consortium. Annals of Surgery. 2005; 242: 314–325.