Brief Article
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World J Transplant. Dec 24, 2013; 3(4): 127-133
Published online Dec 24, 2013. doi: 10.5500/wjt.v3.i4.127
Isolated small bowel transplantation outcomes and the impact of immunosuppressants: Experience of a single transplant center
Ibtesam A Hilmi, Raymond M Planinsic, Ramona Nicolau-Raducu, Daniela Damian, Ali Al-Khafaji, Tetsuro Sakai, Kareem Abu-Elmagd
Ibtesam A Hilmi, Raymond M Planinsic, Daniela Damian, Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, United States
Ramona Nicolau-Raducu, Department of Anesthesiology, Ochsner Health System, New Orleans, LA 70121, United States
Ali Al-Khafaji, Transplant Intensive Care Unit, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States
Kareem Abu-Elmagd, Center for Gut Rehabilitation and Transplantation, Cleveland, OH 44195, United States
Author contributions: Hilmi IA wrote the study protocol and study design, collected the data, and wrote the manuscript; Planinsic RM reviewed the scientific material and edited the manuscript; Nicolau-Raducu R and Damian D collected the data and performed the statistical analysis; Al-Khafaji A reviewed the scientific material and study design and participated in data collection and analysis; Sakai T and Abu-Elmagd K provided the data, served as scientific advisors, and participated in the manuscript writing.
Supported by The Department of Anesthesiology at the University of Pittsburgh Medical Center
Correspondence to: Ibtesam A Hilmi, MBCHB, FRCA, Associate Professor of Anesthesiology, Department of Anesthesiology, University of Pittsburgh Medical Center, Presbyterian Hospital, C-wing Suite 200,200 Lothrop St., Pittsburgh, PA 15213, United States. hilmiia@anes.upmc.edu
Telephone: +1-412-6473262 Fax: +1-412-6476290
Received: March 15, 2013
Revised: June 4, 2013
Accepted: July 18, 2013
Published online: December 24, 2013
Abstract

AIM: To investigate patient and graft outcomes in isolated small bowel transplant (SBTx) recipients and immunosuppressant induction agent impact on outcomes.

METHODS: A retrospective review of the perioperative data of patients who underwent SBTx transplant during an 8-year period was conducted. The intraoperative data were: patient demographics, etiology of short gut syndrome, hemodynamic parameters, coagulation profiles, intraoperative fluid and blood products transfused, and development of post-reperfusion. The postoperative data were: hospital/intensive care unit stays, duration of mechanical ventilation, postoperative incidence of acute kidney injury, and 1-year patient and graft outcomes. The effects of the three immunosuppressant induction agents (Zenapax, Thymoglobulin, Campath) on patient and graft outcomes were reviewed.

RESULTS: During the 8-year period there were 77 patients; 1-year patient and graft survival were 95% and 86% respectively. Sixteen patients received Zenapax, 22 received Thymoglobulin, and 39 received Campath without effects on patient or graft survival (P = 0.90, P =

0.14, respectively). The use of different immune induction agents did not affect the incidence of rejection and infection during the first 90 postoperative days (P = 0.072, P = 0.29, respectively). The Zenapax group received more intraoperative fluid and blood products and were coagulopathic at the end of surgery. Zenapax and Thymoglobulin significantly increased serum creatinine at 48 h (P = 0.023) and 1 wk (P = 0.001) post-transplant, but none developed renal failure or required dialysis at the end of the first year.

CONCLUSION: One-year patient and graft survival were 95% and 86%, respectively. The use of different immunosuppressant induction agents may affect the intraoperative course and short-term postoperative morbidities, but not 1-year patient and graft outcomes.

Keywords: Small bowel transplant, Outcomes, Immune induction agents, Zenapax, Thymoglobulin, Campath

Core tip: Small bowel transplant (SBTx) is the treatment of choice for patients with intestinal failure. However, patient and graft survival can be affected by multiple factors, such as the choice of immunosuppressant and immune induction agent. Studying the effects of these agents may help care providers customize the immunosuppressant protocol to the individual patient. In this study, we reviewed in great detail how different immune induction agents can impact the intraoperative and postoperative course, as well as the short term outcome of these patients. Such information can be of great value to physicians who treat SBTx recipients.