Results of Intestinal and Multivisceral Transplantation in Adult Patients: Italian Experience

We report our experience with intestinal and multivisceral transplantation in Italy. We performed 23 adult isolated intestinal transplants and seven multivisceral ones, three with liver, between December 2000 and June 2005. Indications for transplantation were loss of venous access ( n = 14), recurrent sepsis ( n = 10), and electrolyte-fluid imbalance ( n = 6), 14 of whom also presented with total parenteral nutrition (TPN)-related liver dysfunction. Immunosuppression was based on induction agents like daclizumab (followed by tacrolimus and steroids) in the first period; alemtuzumab or thymoglobulin (with tacrolimus) in a second period after 2002. The mean follow-up was 742 ± 550 days. Three-year patient actuarial survival rate was 88% for intestinal transplants and 42% for multivisceral ( P = .015). Three-year graft actuarial survival rate was 73% for intestinal patients and 42.8% for multivisceral ( P = .1). Graft loss was mainly due to rejection (57%). Complications were mainly represented by bacterial infections (92% of patients), relaparotomies (82%), and rejections (72%). Full bowel function without any parenteral nutrition or intravenous fluid support was achieved in 60% of recipients with functioning bowel including 95% on a regular diet. One patient underwent abdominal wall transplantation as well. Intestinal transplantation has achieved high rates of patient and graft survival with even longer follow-up. Early referral of patients, especially in cases of TPN-liver disease, is mandatory to obtain good outcomes and avoid high mortality rates on the transplant waiting list. Immunosuppressive management remains the key factor to increase the success rate.