Clinical intestinal transplantation: focus on complications.

Abstract

Nine intestinal transplants (three adults, six children) have been performed at the University of Pittsburgh since the advent of FK 506. Eight patients had a combined liver-intestinal transplant, one had a solitary intestinal graft. Four of these were performed 3 to 5 weeks before this report, the other five are presented with 5- to 16-month follow-ups. The clinical profiles of the patients at transplantation are presented in Table 1. Eight patients are alive with the original grafts including the patient with the solitary intestinal graft. One patient died. The methods and techniques have been previously reported. 1–4 Briefly, the solitary intestinal transplant was arterialized from the infrarenal aorta and drained into the recipient superior mesenteric vein. In the case of the liver-intestinal combination, seven were placed piggyback 5 onto the recipient inferior vena cava (IVC) and, in one case, the retrohepatic IVC was replaced by the respective donor cava. Arterialization was from the infrarenal aorta with the use of fresh vascular grafts. A portocaval shunt provided permanent drainage of the recipient portal vein (PV) in two cases. In the remaining cases, the PV of the recipient was drained into the PV of the donor. A temporary portacaval shunt during the procedure was used in three cases, because test clamping caused unacceptable congestion. Intestinal continuity was established at the time of the surgery in all cases but one who had a double enterostomy. Both ends of the intestinal graft were exteriorized in the first five cases and closed 8 to 16 weeks later. In the latter four cases in the series, only the distal end was exteriorized. Immunosuppression was with FK 506 and prednisone supplementation. 6 Azathioprine was given when sufficient FK 506 could not be administered mainly because of renal impairment. Patient characteristics at transplantation and outcome are shown in Table 1. Three patients are living at home, two of them are totally independent of any from of intravenous (IV) therapy. The difficulties encountered during the postoperative course are summarized in Table 2.