The long-term efficacy of multivisceral transplantation.

Between May 2. 1990 and August 18. 1999. a total of 135 intestinal transplants were performed at our center. Of these. 18 (13%) were multiviseeraL which included stomach. duodenum. pancreas. and intestine. The liver was part of the graft in all but three cases and donor colon was included in 10 (56%). Nine were adults and 10 were females. Of the 18 grafts. 15 were primary. and the indications for transplantation were dysmotility syndrome (35%). splanchnic thrombosis (24%). gut neoplasm (18%). and others (24%). Before transplantation. mean (:':SD) bilirubin was II :': 16 mgldL and mean number of abdominal operations was 2.2 :': 1.2. and most patients received TPN for a mean period of 29 :': 19 months. All donors were cadaveric and ABO identical with random HLA match. and no attempts were made to immunomodulate the graft. Lymphocytotoxic crossmatch was positive in two (11 %) patients. and 44% of the donors were cytomegalovirus (CMV) positive. The mean cold ischemia time was 8.5 :!: 1.7 hours. and the operative time was 13.8 :!: 3.3 hours. The details of the donor and recipient operations have been described elsewhere.2•3 Tacrolimus and steroids were the baseline immunosuppression for all patients. Imuran or Cellcept were used from the outset as a third drug in selected cases. Cytoxan or Daclizumab were used as induction therapy for a few cases. Unmodified donor bone marrow cells were infused perioperatively as a single dose (3 to 5 x 10" cell/kg body weight) in three (17%) recipients. The postoperative management protocol was described elsewhere. l .4 and follow-up was to October 30. 1999 with a minimum of 3 and maximum of 98 months.