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Comparable outcomes in intestinal retransplantation: Single‐center cohort study
Author(s) -
Ekser Burcin,
Kubal Chandrashekhar A.,
Fridell Jonathan A.,
Mangus Richard S.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13290
Subject(s) - medicine , immunosuppression , single center , transplantation , surgery , intestinal failure , cohort , retrospective cohort study , gastroenterology
Background Graft loss in intestinal transplantation (ITx) is close to 25% in the first year and 50% at 5‐year post‐transplantation. Although technically and immunologically challenging, intestinal retransplantation is now the 4th most common indication for ITx. Methods The aim of this study was to review and compare the outcomes of intestinal retransplantation with primary ITx, which included isolated ITx, modified multivisceral transplantation (mMVTx), and full MVTx, between 2003 and 2014 at Indiana University. Results Of 218 ITx, 18 (8.3%) were retransplantation. Causes of graft loss were rejection(78%), pancreatitis (11%), and severe intestine dismotility (11%). MVTx (16/18, 89%) was the preferred retransplantation option. In 7 (39%) patients, graftectomy was performed between primary and intestinal retransplantation. Median interval between primary ITx and retransplantation was 421 days. Although patient and graft survival rates at 1 year, 3 years, and 5 years were comparable between primary and retransplants, the number of retransplants was limited in the follow‐up after post‐transplant year 3. Conclusions We identified that timing of retransplantation, graftectomy prior to retransplant allowing an immunosuppression free state, inclusion of the liver, and preserved renal function are important factors in the consideration of intestinal retransplantation. Immunological aspects remain challenging in the decision making and for short‐ and long‐term outcomes.