Intestinal Transplantation and Autologous Reconstructive Surgery in Adults at a Single Italian Center

Abstract

Introduction: Various nonsurgical and surgical therapeutic options emerged in the last decades for patients with chronic intestinal failure and associated life-threatening complications. Intestinal transplantation and autologus intestinal reconstruction are mature therapies with formal indications. Patients and methods: An adult intestinal rehabilitation program started in 2000 at our institution. From December 2000 to December 2016, 131 patients were referred for surgical intestinal rescue. All patients experienced several life threatening complications or high stoma output: 51 intestinal/multivisceral transplantations were performed in 50 adult patients; in 6 of these patients abdominal wall transplantation was combined. In the same period 81 patients underwent different type of autologus intestinal reconstruction: 33 patients had short bowel syndrome, other underlying diseases were represented by multiple strictures, intestinal fistulas, intestinal dismotility and cocoon syndrome. Results: After a median follow up of 2332 days (1–5673 days), 22 transplanted patients are currently alive with 1-3-5-10 year patient survival rates of 78%, 60%, 55% and 48% respectively; the 1-3-5-10 year graft survival rates are 68%, 54%, 50% and 43% respectively. Autologus intestinal reconstruction surgery included intestinal resection, adhesiolyses and/or intestinal reconnection surgery, serial transverse enteroplasty. After a mean follow-up of 1199 (8–3753), 75 patients (92%) are alive with 1–3 and 5 year survival rates of 94%, 94% and 90% respectively. Five of these patients were initially listed for intestinal/multivisceral transplantation and then removed after successful AIR surgery. After surgery, 9 patients were lost at follow up, 6 patients died, of the remaining 66 patients, 79% are completely off TPN, 11% experienced 50% reduction of TPN amount, 6% a 25% reduction, 4 % failed AIR and 2 were listed for transplant. Conclusions: Even, if results improved over the past 20 years, the 10-year survival rate after intestinal transplant still does not exceed 50%. A decline in the rate of intestinal transplant as well as the number of new candidates on the waiting list is observed worldwide. Intestinal transplantation, with new specific indications, remains an excellent option for patients with severe life-threatening complications who are not candidates or failed autologus gastrointestinal reconstruction surgery.