Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection

作     者：Guosheng Wu Ruy J.Cruz Jr 

作者机构：Department of Gastrointestinal SurgeryXijing Hospital of Digestive DiseasesThe Fourth Military Medical UniversityXi’anShannxiChina Thomas E.Starzl Transplantation InstituteUniversity of Pittsburgh Medical CenterPittsburghPAUSA 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2018年第6卷第1期

页      面：29-37,I0001,I0002页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Intestinal transplant immunosuppression rejection infection 

摘      要：Background and aims:A co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury;however,detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to *** aimof the study was to compare immune-mediated injury,causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant(LITx)or liver-exclusive intestinal transplant(LETx).Methods:Between May 2000 and May 2010,212 adult patients undergoing LITx(n¼76)and LETx(n¼136)were *** underwent either liver combined intestinal or full multivisceral *** underwent either isolated intestinal or modified multivisceral ***:During 44.9631.4 months of follow-up,death-censored intestinal graft survival was significantly higher for LITx than LETx(96.9%,93.2%and 89.9%vs 91.4%,69.3%and 60.0%at 1,3 and 5 years;p¼0.0001).Incidence of graft loss due to rejection was higher in LETx than in LITx(30.9%vs 6.6%;p0.0001),while infection was the leading cause of graft loss due to patient death in LITx(25.0%vs 5.1%;p0.0001).Despite similar immunosuppression,the average number(0.87 vs 1.42,p¼0.02)and severity of acute cellular rejection episode(severe grade:7.9%vs 21.3%;p¼0.01)were lower in LITx than in *** of acute antibody-mediated rejection was also significantly lower in LITx than in LETx(3.6%vs 15.2%;p¼0.03).Incidence of chronic rejection was reduced in LITx(3.9%vs 24.3%;p¼0.0002).Conclusions:Intestinal allografts with a liver component appear to decrease risk of rejection but increase risk of *** findings emphasize that LITx has characteristic immunologic and clinical *** immunosuppression may need to be considered for patients who undergo LITx to attenuate increased risk of infection.