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Long-Term Survival, Nutritional Autonomy and Quality of Life after Intestinal and Multivisceral Transplantation
Kareem M Abu-Elmagd, Guilherme Costa*, Beverly Kosmach-Park*, Geoffrey J Bond*, Kyle Soltys*, Rakesh Sindhi*, Darlene Koritsky*, Lillian Martin*, George Mazariegos
Thomas E. Starzl Transplantation Institute, Pittsburgh, PA

OBJECTIVE(S):To assess long-term survival, graft function and health-related quality of life after intestinal/multivisceral transplantation.
METHODS:A prospective cross-sectional study was performed on survivors beyond 5-year milestone. Clinical data(20 variables) were analyzed to identify factors associated with long-term patient survival and graft function. Quality of life was assessed by direct contact and standardized self-reported quality of life inventory(QOLI);130 questionnaire with 26 domains.
RESULTS:Between 1990-2006, 376 patients(210 adults,166 children) were transplanted with 429 grafts achieving 5-year recipient and graft actuarial survival of 60% and 50%; respectively. All patients failed TPN with 220(59%) requiring simultaneous hepatic replacement. With follow-up of 10+14 years, 177(90 adults,87 children) are alive with full nutritional autonomy in 168(95%) achieving serum albumin of 3.7+0.5gm/dl. Re-transplantation rescued 25(14%) and 15(9%) required kidney transplantation. With 46% prednisone-free on spaced-doses of tacrolimus, serum creatinine is 1.1+0.4mg/dl. Of the 177 survivors, 54 are beyond 10-21 years. Survival predictors are absent donor-specific antibodies, allograft/recipient preconditioning, liver-inclusion and social/family support. Most QOLI-scores were significantly(p<0.05) better in survivors compared to patients with chronic organ failure. In contrast to general population, physical scores were lower(p<0.05) with similar neuropsychiatric domains. Factors associated with impaired QOLI were dysmotility(54%), hypertension(36%), impaired skeletal health(16%) and diabetes(15%) with higher prevalence among adults. Of pediatric survivors, 32% are adults with 90% students/graduates/employed. Of adults, 86% are totally independent; 68% employed, 21% homemakers and 11% seniors. Six survivors gave birth/fathered child.
CONCLUSIONS:Visceral transplantation is durable life-saving surgery with high long-term rehabilitative indices. Further improvement is anticipated by continual refinement of current immunologic and long-term management.

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