Isolated intestinal versus composite visceral allografts: causes of graft failure.

Between May 2, 1990 and May 4, 1999. 124 consecutive patients received a total of 130 intestinal allografts: 51 isolated intestine and 79 composite visceral grafts (62 liver :!: intestine and 17 multivisceral). Of these. 73 (59%) were children and 51 (41%) were adults. All grafts were cadaveric and ABO identical. No attempts were made to alter the graft immunologic tissue with irradiation. antilymphocyte preparations. or other modalities. HLA matching was random and crossmatch testing was positive in 18% of the grafts. The mean cold ischemia time was 8.7 :!: 7 hours. Baseline immunosuppression was done with tacrolimus and steroids. and daclizumab was used as induction therapy in the last 17 grafts. A single dose of unmodified donor bone marrow cells (3 to 5 x lOS cells/kg body weight) was infused intravenously during the first 24 hours after transplantation in 26 recipients. Azathioprine or mycophenolate mofetil was given from the outset in selected cases. Steroid-resistant rejection was treated with OKT3. Details of the donor and recipient operations were previously published 1-4 and the same immunosuppressive protocol was used for both the isolated intestinal and composite visceral recipients as described elsewhere.1.4 Chi-square and Fisher Exact tests were used for statistical analysis.