Liver inclusion improves outcomes of intestinal retransplantation in adults. [Corrected

Abstract

Retransplantation is a viable treatment option for patients with primary intestinal graft loss. We analyzed outcomes of retransplantations (n = 23) in adults from May 2000 to May 2010 at our center and compared patients who received liver-free retransplantations (n = 13) with those who received liver-inclusive retransplantations (n = 10). The overall survival rates at 1, 3, and 5 years in retransplantations were 90.9%, 67.1%, and 59.7% (patient) and 82.2%, 58.6%, and 51.3% (graft), respectively, which were similar to the rates in primary transplants. The patient survival rates at 1, 3, and 5 years were 91.7%, 55.6%, and 41.7%, respectively, in liver-free retransplantations, as compared to rates of 90.0%, 80.0%, and 80.0% in liver-inclusive retransplantations. The graft survival rates at 1, 3, and 5 years in liver-free retransplantations were 76.2%, 40.6%, and 27.1%, respectively, which were significantly worse than those in liver-inclusive retransplantations (P = 0.03). Within an average follow-up of 32.3 months, 8 of 13 (61.5%) of liver-free retransplantations underwent enterectomy because of severe acute cellular rejection (n = 3) or chronic rejection (n = 5). Six of 13 (46.2%) recipients succumbed to rejection-related complications. Compared to liver-free retransplantations, the rate and severity of acute rejection were markedly de creased in liver-inclusive retransplantations, and no chronic rejection was seen. Within an average follow-up of 44.5 months, two of 10 (20%) died due to graft-versus-host disease and infection, respectively. A liver-inclusive retransplantation offers a better long-term patient and graft survival, suggesting that including the liver as part of an intestinal graft should be considered in adult recipients when retransplantation is necessary.