100 Multivisceral transplants at a single center

Andreas G. Tzakis, Tomoaki Kato, David M. Levi, Werviston DeFaria, Gennaro Selvaggi, Debbie Weppler, Seigo Nishida, Jang Moon, Juan R. Madariaga, Andre I. David, Jeffrey J. Gaynor, John F. Thompson, Erick Hernandez, Enrique Martinez, G. Patricia Cantwell, Jeffrey S. Augenstein, Anthony Gyamfi, Ernesto A. Pretto, Lorraine Dowdy, Panagiotis TryphonopoulosPhillip Ruiz, Goran B. Klintmalm, Thomas E. Starzl, Kareem M. Abu-Elmagd, David Grant, John S. Najarian, Donald D. Trunkey

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Objective: The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status. Summary Background Data: Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft. Methods: This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date. Results: The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65% and 63% at 1 year, 49% and 47% at 3 years, and 49% and 47% at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the time of transplant (P = 0.05), and being a child who received Campath-1H induction (P = 0.03). Among 37 patients who had none of these 3 factors (15 adults and 22 children), estimated 1- and 3-year survivals were 89% and 71%, respectively. Patients transplanted since 2001 had significantly less moderate and severe rejections (31.6% vs 67.6%, P = 0.0005) with almost half of these patients never developing rejection. Conclusions: Multivisceral transplantation is now an effective treatment of patients with complex abdominal pathology. The incidences of serious acute rejection and patient survival have improved in the most recent experience. Our results show that the multivisceral graft seems to facilitate engraftment of transplanted organs and raises the possibility that there is a degree of immunologic protection afforded by this procedure.

Original languageEnglish (US)
Pages (from-to)480-493
Number of pages14
JournalAnnals of Surgery
Volume242
Issue number4
DOIs
StatePublished - Oct 2005
Externally publishedYes

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Transplants
Transplantation
Survival
Gastroschisis
Graft Rejection
Graft Survival
Thrombosis
Outcome Assessment (Health Care)
Pathology
Incidence
Wounds and Injuries
Therapeutics
Population

ASJC Scopus subject areas

  • Surgery

Cite this

Tzakis, A. G., Kato, T., Levi, D. M., DeFaria, W., Selvaggi, G., Weppler, D., ... Trunkey, D. D. (2005). 100 Multivisceral transplants at a single center. Annals of Surgery, 242(4), 480-493. https://doi.org/10.1097/01.sla.0000183347.61361.7a

100 Multivisceral transplants at a single center. / Tzakis, Andreas G.; Kato, Tomoaki; Levi, David M.; DeFaria, Werviston; Selvaggi, Gennaro; Weppler, Debbie; Nishida, Seigo; Moon, Jang; Madariaga, Juan R.; David, Andre I.; Gaynor, Jeffrey J.; Thompson, John F.; Hernandez, Erick; Martinez, Enrique; Cantwell, G. Patricia; Augenstein, Jeffrey S.; Gyamfi, Anthony; Pretto, Ernesto A.; Dowdy, Lorraine; Tryphonopoulos, Panagiotis; Ruiz, Phillip; Klintmalm, Goran B.; Starzl, Thomas E.; Abu-Elmagd, Kareem M.; Grant, David; Najarian, John S.; Trunkey, Donald D.

In: Annals of Surgery, Vol. 242, No. 4, 10.2005, p. 480-493.

Research output: Contribution to journalArticle

Tzakis, AG, Kato, T, Levi, DM, DeFaria, W, Selvaggi, G, Weppler, D, Nishida, S, Moon, J, Madariaga, JR, David, AI, Gaynor, JJ, Thompson, JF, Hernandez, E, Martinez, E, Cantwell, GP, Augenstein, JS, Gyamfi, A, Pretto, EA, Dowdy, L, Tryphonopoulos, P, Ruiz, P, Klintmalm, GB, Starzl, TE, Abu-Elmagd, KM, Grant, D, Najarian, JS & Trunkey, DD 2005, '100 Multivisceral transplants at a single center', Annals of Surgery, vol. 242, no. 4, pp. 480-493. https://doi.org/10.1097/01.sla.0000183347.61361.7a
Tzakis AG, Kato T, Levi DM, DeFaria W, Selvaggi G, Weppler D et al. 100 Multivisceral transplants at a single center. Annals of Surgery. 2005 Oct;242(4):480-493. https://doi.org/10.1097/01.sla.0000183347.61361.7a
Tzakis, Andreas G. ; Kato, Tomoaki ; Levi, David M. ; DeFaria, Werviston ; Selvaggi, Gennaro ; Weppler, Debbie ; Nishida, Seigo ; Moon, Jang ; Madariaga, Juan R. ; David, Andre I. ; Gaynor, Jeffrey J. ; Thompson, John F. ; Hernandez, Erick ; Martinez, Enrique ; Cantwell, G. Patricia ; Augenstein, Jeffrey S. ; Gyamfi, Anthony ; Pretto, Ernesto A. ; Dowdy, Lorraine ; Tryphonopoulos, Panagiotis ; Ruiz, Phillip ; Klintmalm, Goran B. ; Starzl, Thomas E. ; Abu-Elmagd, Kareem M. ; Grant, David ; Najarian, John S. ; Trunkey, Donald D. / 100 Multivisceral transplants at a single center. In: Annals of Surgery. 2005 ; Vol. 242, No. 4. pp. 480-493.
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abstract = "Objective: The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status. Summary Background Data: Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft. Methods: This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date. Results: The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65{\%} and 63{\%} at 1 year, 49{\%} and 47{\%} at 3 years, and 49{\%} and 47{\%} at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the time of transplant (P = 0.05), and being a child who received Campath-1H induction (P = 0.03). Among 37 patients who had none of these 3 factors (15 adults and 22 children), estimated 1- and 3-year survivals were 89{\%} and 71{\%}, respectively. Patients transplanted since 2001 had significantly less moderate and severe rejections (31.6{\%} vs 67.6{\%}, P = 0.0005) with almost half of these patients never developing rejection. Conclusions: Multivisceral transplantation is now an effective treatment of patients with complex abdominal pathology. The incidences of serious acute rejection and patient survival have improved in the most recent experience. Our results show that the multivisceral graft seems to facilitate engraftment of transplanted organs and raises the possibility that there is a degree of immunologic protection afforded by this procedure.",
author = "Tzakis, {Andreas G.} and Tomoaki Kato and Levi, {David M.} and Werviston DeFaria and Gennaro Selvaggi and Debbie Weppler and Seigo Nishida and Jang Moon and Madariaga, {Juan R.} and David, {Andre I.} and Gaynor, {Jeffrey J.} and Thompson, {John F.} and Erick Hernandez and Enrique Martinez and Cantwell, {G. Patricia} and Augenstein, {Jeffrey S.} and Anthony Gyamfi and Pretto, {Ernesto A.} and Lorraine Dowdy and Panagiotis Tryphonopoulos and Phillip Ruiz and Klintmalm, {Goran B.} and Starzl, {Thomas E.} and Abu-Elmagd, {Kareem M.} and David Grant and Najarian, {John S.} and Trunkey, {Donald D.}",
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T1 - 100 Multivisceral transplants at a single center

AU - Tzakis, Andreas G.

AU - Kato, Tomoaki

AU - Levi, David M.

AU - DeFaria, Werviston

AU - Selvaggi, Gennaro

AU - Weppler, Debbie

AU - Nishida, Seigo

AU - Moon, Jang

AU - Madariaga, Juan R.

AU - David, Andre I.

AU - Gaynor, Jeffrey J.

AU - Thompson, John F.

AU - Hernandez, Erick

AU - Martinez, Enrique

AU - Cantwell, G. Patricia

AU - Augenstein, Jeffrey S.

AU - Gyamfi, Anthony

AU - Pretto, Ernesto A.

AU - Dowdy, Lorraine

AU - Tryphonopoulos, Panagiotis

AU - Ruiz, Phillip

AU - Klintmalm, Goran B.

AU - Starzl, Thomas E.

AU - Abu-Elmagd, Kareem M.

AU - Grant, David

AU - Najarian, John S.

AU - Trunkey, Donald D.

PY - 2005/10

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N2 - Objective: The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status. Summary Background Data: Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft. Methods: This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date. Results: The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65% and 63% at 1 year, 49% and 47% at 3 years, and 49% and 47% at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the time of transplant (P = 0.05), and being a child who received Campath-1H induction (P = 0.03). Among 37 patients who had none of these 3 factors (15 adults and 22 children), estimated 1- and 3-year survivals were 89% and 71%, respectively. Patients transplanted since 2001 had significantly less moderate and severe rejections (31.6% vs 67.6%, P = 0.0005) with almost half of these patients never developing rejection. Conclusions: Multivisceral transplantation is now an effective treatment of patients with complex abdominal pathology. The incidences of serious acute rejection and patient survival have improved in the most recent experience. Our results show that the multivisceral graft seems to facilitate engraftment of transplanted organs and raises the possibility that there is a degree of immunologic protection afforded by this procedure.

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