Intestinal failure requiring
total parenteral nutrition (TPN) is associated with significant morbidity and mortality. Intestinal
transplantation can be a lifesaving option for patients with
intestinal failure who develop serious TPN-related complications. The aim of this study was to evaluate survival, surgical technique, and patient care in patients treated with intestinal
transplantation. We reviewed data collected from 95 consecutive intestinal transplants performed between December 1994 and November 2000 at the University of Miami. Fifty-four of the patients undergoing intestinal
transplantation were children and 41 were adults. The series includes 49 male and 46 female patients. The causes of
intestinal failure included
mesenteric venous thrombosis (n = 12),
necrotizing enterocolitis (n = 11),
gastroschisis (n = 11), midgut
volvulus (n = 9),
desmoid tumor (n = 8),
intestinal atresia (n = 6),
trauma (n = 5),
Hirschsprung's disease (n = 5),
Crohn's disease (n = 5),
intestinal pseudoobstruction (n = 4), and others (n = 19). The procedures performed included 27 isolated intestine transplants, 28 combined liver and intestine transplants, and 40 multivisceral transplants. Since 1998, we have been using
daclizumab (Zenepax) for induction of immunosuppression and zoom videoendoscopy for graft surveillance. We began to use intense cytomegalovirus prophylaxis and systemic drainage of the portal vein. The 1-year patient survival rates for isolated intestinal, liver and intestinal, and multivisceral
transplantations were 75%, 40%, and 48%, respectively. Since 1998, the 1-year patient and graft survival rates for isolated intestinal transplants have been 84% and 72%, respectively. The causes of death were as follows:
sepsis after rejection (n = 14),
respiratory failure (n = 8),
sepsis (n = 6),
multiple organ failure (n = 4), arterial graft
infection (n = 3),
aspergillosis (n = 2), post-
transplantation lymphoproliferative disease (n = 2),
intracranial hemorrhage (n = 2), and
fungemia, chronic rejection, graft vs. host disease,
necrotizing enterocolitis,
pancreatitis,
pulmonary embolism, and
viral encephalitis (n = 1 case of each). Intestinal
transplantation can be a lifesaving alternative for patients with
intestinal failure. The prognosis after intestinal
transplantation is better when it is performed before the onset of
liver failure. Rejection monitoring with zoom videoendoscopy and new immunosuppressive therapy with
sirolimus,
daclizumab, and
campath-1H have contributed to the improvement in patient survival.