Two decades of intestinal transplantation (ITx) in Leuven.

Mathias Clarysse ^{1, 2}, Laurens Ceulemans ^{1, 2}, Emilio Canovai ^{1, 2}, Glen Van Helleputte ^{1, 2}, Mark Waer ³, Gert Van Assche ², Martin Hiele ², Ina Jochmans ^{1, 2}, Tim Vanuytsel ², Diethard Monbaliu ^{1, 2}, Jacques Pirenne ^{1, 2, 3}

¹ Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Abdominal Transplant Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
² Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Belgium.
³ Experimental Transplantation Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.

Introduction: ITx was initiated at the University Hospitals Leuven in 2000 after preclinical animal studies. We report our long-term experience.

Methods: In 2000-2019 19 ITx were performed in 19 patients. Data were extracted from a prospectively maintained database. Kaplan-Meier was used for survival estimation.

Results: Median follow-up is 6yr 11mth (1yr-16yr). Median age was 40yr 5mth (2yr 9mth-56yr 8mth); male/female ratio was 9/10; peds/adult ratio was 4/15. Indications were complicated intestinal failure/disease not treatable by any other means and due to: ischemia (4), volvulus (4), splanchnic thrombosis (4), Crohn (2), chronic intestinal pseudo-obstruction (3), microvillus inclusion disease (1), Churg-Strauss (1). 9 were isolated ITx, 6 combined liver-ITx, and 4 MVTx. 4 received a kidney and 2 a colonic segment. 1 was a live-donor Tx. MVTx was done after visceral artery embolisation, dramatically reducing blood loss. The Leuven immunomodulatory protocol {Donor-specific blood transfusion, low Immunosuppression (IS), reduced periTx inflammation} promoting T-regs was used in 17 recipients. In total 2 severe grade 3 early Acute Rejections (AR) in 2 patients (10,5%) and 4 severe grade 3 late AR in 3 patients (15%) were seen. There was no graft loss to rejection except in the live-donor recipient in whom a transplantectomy was done 7 mths postTx. Renal failure was not seen except in 1 combined kidney Tx recipient. No patients developed PTLD. 4 died (2 aspergillus, 1 NSAID-induced graft ischemia, 1 sepsis). Of the 15 survivors, 13 are nutritionally independent. In 2, a transplantectomy was done (1 graft ischemia > protocol biopsy; 1 multiresistent CMV enteritis). The latter is listed for reTx. So far no proven chronic rejection / late immunological graft loss was seen. 1/10yr patient & graft survival are 90%/84% & 84%/77%. Costs of ITx (albeit >other organ Tx) become lower than TPN >2yrs. Launch of a comprehensive/multidisciplinary intestinal failure center has increased patient referral. 3 are awaiting ITx, 1 combined liver-ITx, and 4 MVTx.

Conclusion: Long-term outcome of ITx under low IS compares favorably with global data and other organ Tx. PreTx embolisation dramatically changed the nature of MVTx. Survival equal or superior to TPN, better quality-of-life, and cost-effectiveness support application of ITx earlier in the course of intestinal failure. With growing waiting list at our center, referral of suitable intestinal donors is critical.

Session:

Poster Viewing

Presenter/s:

Mathias Clarysse

Presentation type:

Poster only presentation

Room:

Galeries and Marie Curie

Date:

Friday, July 5, 2019

Time:

17:45 - 19:00

Session times:

17:45 - 19:00