Original Scientific ArticlesClinical Intestinal Transplantation: New Perspectives and Immunologic Considerations 1
Section snippets
Recipient
Case accrual was between May 2, 1990 and August 11, 1997, during which 98 patients received 104 intestinal grafts: 35 alone, 48 with a liver, and 15 as part of a multivisceral graft. Of the 6 retransplantations, 2 were isolated intestine and 4 were liver-intestine or multivisceral. Children (0.5–16.8 years) outnumbered adults (18–58 years), and gender distribution was nearly equal. Other demographic and clinical features are summarized in Table 1. The causes of intestinal failure are listed in
Overall
Current survivors who are still bearing their grafts (n = 47) have been followed up for 32 ± 26 months (range, 1–86 months); 2 are successful retransplant recipients (one isolated intestine, and one combined liver-intestine). Fifteen recipients survived more than 5 years. Kaplan-Meier survival rate is 72% at 1 year and 48% at 5 years (Fig. 2). Most of the deaths occurred during the first 30 postoperative months.
The survival rate was similar among the three different types of transplantation (p
Discussion
Empirical progress in organ transplantation depended for 30 years on a search for more potent baseline immunosuppressants, without understanding the basis for the prototypic immunologic confrontation (rejection) and involution (“graft acceptance”) that was first observed in kidney recipients treated with azathioprine and prednisone.[36]The advent of cyclosporine elevated the expectations with transplantation of most organs to the level of patient service, but the resulting revolution largely
Acknowledgements
Acknowledgment:
We would like to thank Dolly Martin, Lynn Ostrowski, Anita Krajack, Mauricio Geraldo, MD, and Scott Miller for their great help in data collection.
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This study was supported in part by Project Grant No. DK 29661 from the National Institutes of Health, Bethesda, MD.