TY - JOUR
T1 - The Miami Experience With Almost 100 Multivisceral Transplants
AU - Tzakis, A. G.
AU - Kato, T.
AU - Nishida, S.
AU - Levi, D. M.
AU - DeFaria, W.
AU - Selvaggi, G.
AU - Weppler, D.
AU - Moon, J.
AU - Madariaga, J. R.
AU - David, A. I.
AU - Gaynor, J. J.
AU - Thompson, J.
AU - Hernandez, E.
AU - Tuteja, S.
AU - Tryphonopoulos, P.
AU - Ruiz, P.
N1 - Funding Information:
This study was partially supported by NIH grant 1 R03 DK061445-01 A2 and was also presented before the American Surgical Association (Tzakis A, Kato T, Levi D, et al: One hundred cases of multivisceral transplantation. Annals of Surgery, in press) at the 125th Annual Meeting, Palm Beach, Fl, April 14–16, 2005.
PY - 2006/7
Y1 - 2006/7
N2 - We report our experience with 98 patients who received primary multivisceral transplantations. Three eras can be distinguished based on the evolution of technique, immunosuppression, and monitoring: August 1994 to December 1997 (first era); January 1998 to December 2000 (second era); and January 2001 to present (third era). Sixteen patients were transplanted during the first era, 18 during the second era, and 64 during the third era. Fifty-three patients are alive with a median follow-up of 37.5 months (range: 1 to 116 months). The leading cause of mortality was infection (n = 17), followed by rejection (n = 6). Seven patients required retransplantation and five of them subsequently died. The estimated 3-year survival was 25% ± 11% for era 1; 44% ± 12% for era 2; and 58% ± 7% for era 3. Additionally, 45.3% (29/64) of patients in the third era never developed rejection versus 23.5% (8/34) of patients in the first two eras combined. The percentage of patients who developed a moderate or severe rejection was significantly less in the third era compared with the first two eras combined, 31.6% (20/64) versus 67.6% (23/34). A comparison of the hazard rate of developing severe rejection showed a protective effect of the multivisceral graft (P = .0001). In conclusion, multivisceral transplantation is indicated for patients with short bowel syndrome and extended abdominal catastrophies. Evolution in surgical techniques, immunosuppression, and monitoring have improved patient survival, which is now similar to that of other complex solid organ transplants.
AB - We report our experience with 98 patients who received primary multivisceral transplantations. Three eras can be distinguished based on the evolution of technique, immunosuppression, and monitoring: August 1994 to December 1997 (first era); January 1998 to December 2000 (second era); and January 2001 to present (third era). Sixteen patients were transplanted during the first era, 18 during the second era, and 64 during the third era. Fifty-three patients are alive with a median follow-up of 37.5 months (range: 1 to 116 months). The leading cause of mortality was infection (n = 17), followed by rejection (n = 6). Seven patients required retransplantation and five of them subsequently died. The estimated 3-year survival was 25% ± 11% for era 1; 44% ± 12% for era 2; and 58% ± 7% for era 3. Additionally, 45.3% (29/64) of patients in the third era never developed rejection versus 23.5% (8/34) of patients in the first two eras combined. The percentage of patients who developed a moderate or severe rejection was significantly less in the third era compared with the first two eras combined, 31.6% (20/64) versus 67.6% (23/34). A comparison of the hazard rate of developing severe rejection showed a protective effect of the multivisceral graft (P = .0001). In conclusion, multivisceral transplantation is indicated for patients with short bowel syndrome and extended abdominal catastrophies. Evolution in surgical techniques, immunosuppression, and monitoring have improved patient survival, which is now similar to that of other complex solid organ transplants.
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U2 - 10.1016/j.transproceed.2006.05.015
DO - 10.1016/j.transproceed.2006.05.015
M3 - Article
C2 - 16908245
AN - SCOPUS:33746887364
SN - 0041-1345
VL - 38
SP - 1681
EP - 1682
JO - Transplantation proceedings
JF - Transplantation proceedings
IS - 6
ER -