Results of intestinal and multivisceral transplantation in adult patients: Italian experience.

PURPOSE: We report our experience with intestinal and multivisceral transplantation in Italy. METHODS: 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. RESULTS: 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. DISCUSSION AND CONCLUSION: 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.