ArticleIntestinal Failure (New York, N.Y.)
Outcomes after intestinal re-transplant: A detailed, single-center analysis of clinical and technical factors.
Article in Intestinal Failure (New York, N.Y.). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intestinal transplantation (ITx) has evolved into a viable option for patients suffering from intestinal failure (IF). As graft and patient survival increase, we enter a new era where re-transplantation (re-ITx) is increasingly considered. Re-ITx grafts historically are less successful than their primary counterpart. While re-ITx is challenging for the obvious reasons of a re-do operation, there are potentially modifiable pre-transplant clinical and technical factors which are not yet understood. Methods: We conducted an in-depth review of our re-ITx experience at a high volume transplant center, and describe unique predictors associated with improved outcomes. Results: There were 132 primary ITx performed from 1991-2021; 44 primary ITx failed (33%) and of those, 25 (56%) were re-transplanted within the time of this retrospective review. The median time to re-ITx was 13 months (5 days-6 years). I-ITx recipients were more commonly re-transplanted with liver-inclusive grafts (64%). Re-ITx recipients were more often male (p=0.05), had positive crossmatch (p=0.01), PRA>20% (p=0.03), and underwent ATG-induction (p=0.00). The mean graft survival in months in primary ITx was 74.0 (0.0 - 303.2) and in re-ITx was 60.0 (0.0 - 155.83) (p=0.37). The leading indication for re-ITx was ACR of the primary graft (64%). Successful re-ITx (graft survival >1 year) was significantly associated with ATG-induction (p=0.003). Liver-inclusive grafts demonstrated increased 1-year survival compared with liver-free grafts, but not significantly (primary ITx: 72% vs 55%; re-ITx: 75% vs 57%). Enterectomy of the primary graft prior to re-ITx appeared to increase overall graft survival after re-ITx, but not significantly (70 vs 40 months, p=0.17). Enterocolonic continuity was associated with overall longer graft survival after re-ITx (95 vs 40 months, p=0.03). Conclusion: We demonstrate several factors to consider when evaluating patients for re-ITx, a multicenter study is needed to understand how patient selection, clinical management, and technical modifications can improve outcomes after re-ITx.
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