Predictors of Long Term Survival in Visceral Transplant Recipients

Abstract

Listen

Translate article

Background: Despite continual improvement in early survival, the long-term outcomes of visceral transplantation remain conservative. Study Design: Single-center retrospective analysis of all visceral allograft recipients who underwent visceral transplant between November 2003 and December 2013 with at least 3 year follow up data. Clinical data from a prospectively maintained database was used to assess outcomes including patient and graft survival. Results: Of 174 recipients, 90 (51.7%) were adults and 84 (48.3%) were pediatric patients. Types of visceral transplants were 98 (56.3%) isolated intestinal transplant, 44 (25.3%) combined liver intestinal transplant, and 32 (18.4%) multi-visceral transplant. Median follow up was 8.1 (3–13.2) years. 3-, 5-, and 10-year overall patient survival was 69.5%, 66%, and 63%, respectively, while 3-, 5-, and 10-year overall graft survival was 67%, 62%, and 61%, respectively. In univariable analysis, significant predictors of survival included pediatric recipient (odds ratio [OR] = 2.138; 95% CI, 1.251-3.656); P= 0.005), low donor/recipient weight ratio (odds ratio [OR] = 1.224; 95% CI, 1.017-1.473; P= 0.032), no episodes of severe acute rejection (odds ratio [OR] = 1.939; 95% CI, 1.160-3.243; P= 0.012), history of functional bowel problem (odds ratio [OR] = 1.950; 95% CI, 1.142-3.332; P= 0.014), no simultaneous kidney transplantation (odds ratio [OR] = 3.138; 95% CI, 1.250-7.880; P= 0.015) and less HLA-A mismatch (odds ratio [OR] = 1.815; 95% CI, 1.098-3.012; P= 0.02). In multivariable analysis, significant predictors of survival included pediatric recipient (odds ratio [OR] = 2.249; 95% CI, 1.256-4.027); P= 0.006), low donor/recipient weight ratio (odds ratio [OR] = 1.234; 95% CI, 1.023-1.488; P= 0.028) and no episodes of severe acute rejection (odds ratio [OR] = 2.032; 95% CI, 1.158-3.566; P= 0.013). Conclusions: Visceral transplantation remains a good option for treatment of end stage intestinal failure with parenteral nutritional complications. Proper graft selection and improvement of immunosuppression regimens could significantly improve the long-term survival.