Outcome After Intestinal Transplantation From Living Versus Deceased Donors

Author:

Ceulemans Laurens J.123,Dubois Antoine1456,Clarysse Mathias145,Canovai Emilio145,Venick Robert7,Mazariegos George8,Vanuytsel Tim1910,Hibi Taizo11,Avitzur Yaron12,Hind Jonathan13,Horslen Simon14,Gondolesi Gabriel15,Benedetti Enrico16,Gruessner Rainer17,Pirenne Jacques145

Affiliation:

1. Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven, Belgium

2. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium

3. Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium

4. Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

5. Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium

6. Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels, Belgium

7. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Mattel Children’s Hospital at UCLA Medical Center, Los Angeles, CA

8. Hillman Center for Pediatric Transplantation, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America

9. Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

10. Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium

11. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

12. Department Gastroenterology, Hepatology, and Nutrition, SickKids Hospital, Toronto, Canada

13. Department of Paediatric Liver, Gastrointestinal and Nutrition Centre, King’s College Hospital, London

14. Department of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA

15. Department of General Surgery, Nutritional Support Unit, Liver, Pancreas, and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina

16. Department of Surgery, University of Illinois Hospital, Chicago, IL

17. Department of Surgery, SUNY Downstate Health Sciences University, New York City, NY

Abstract

Objective: To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short-term and long-term outcomes to a propensity-matched cohort of deceased donors. Background: ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success, but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote center's collaborations. Methods: Based on the ITR, 4156 ITx were performed between January 1987 and April 2019, of which 76 (1.8%) were LD, including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/sex, weight, region, IF-cause, retransplant, pretransplant status, ABO compatibility, immunosuppression, and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. Results: Most LDs were performed in North America (61%), followed by Asia (29%). The mean recipient age was: 22 years; body mass index: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. Fifty-two percent of patients were at home at the time of transplant. One-/5-year patient survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively (P=0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively (P=0.956). Acute rejection was diagnosed in 47% of LD versus 51% of DD (P=0.723). Conclusion: Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

Cited by 6 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Living Donor Intestinal Transplantation;Gastroenterology Clinics of North America;2024-09

2. Intestinal Transplantation in the Developing World;Gastroenterology Clinics of North America;2024-09

3. Current Status of Chronic Intestinal Failure Management in Adults;Nutrients;2024-08-10

4. History of clinical intestinal transplantation;Human Immunology;2024-05

5. Abdominal Organ Transplantation: Noteworthy Literature in 2023;Seminars in Cardiothoracic and Vascular Anesthesia;2024-04-10

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