Isolated small bowel transplantation outcomes and the impact of immunosuppressants: Experience of a single transplant center  

作　　者：Ibtesam A Hilmi Raymond M Planinsic Ramona Nicolau-Raducu Daniela Damian Ali Al-Khafaji Tetsuro Sakai Kareem Abu-Elmagd 

机构地区：[1]Department of Anesthesiology, University of Pittsburgh Medical Center,Presbyterian Hospital,Pittsburgh,PA 15213,United States [2]Department of Anesthesiology,Ochsner Health System,New Orleans,LA 70121,United States [3]Transplant Intensive Care Unit, Department of Critical Care Medicine,University of Pittsburgh School of Medicine,Pittsburgh,PA 15261,United States [4]Center for Gut Rehabilitation and Transplantation,Cleveland,OH 44195,United States

出　　处：《World Journal of Transplantation》2013年第4期127-133,共7页世界移植杂志

基　　金：Supported by The Department of Anesthesiology at the University of Pittsburgh Medical Center

摘　　要：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.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.

关 键 词：Small BOWEL TRANSPLANT OUTCOMES Immune induction agents ZENAPAX THYMOGLOBULIN Campath 

分 类 号：R[医药卫生]