Five Hundred Intestinal and Multivisceral Transplantations at a Single Center Major Advances With New Challenges
Five Hundred Intestinal and Multivisceral Transplantations at a Single Center Major Advances With New Challenges
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DOI：
10.1097/sla.0b013e3181b67725
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发表时间：
2009-10-01
影响因子：
9
通讯作者：
Mazariegos, George
中科院分区：
文献类型：
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作者：
Abu-Elmagd, Kareem M.;Costa, Guilherme;Mazariegos, George
目的：在外科技术改进的环境下评估内脏移植的发展。新的免疫抑制方案和其他处理策略摘要背景数据：1990年肠道和多脏器移植的临床可行性。需要多方面的创新策略来改善结果，增加程序的实用性。方法：分为3个阶段。453例患者接受了500例内脏移植，在ER1期(5/90~5/94)，主要使用的免疫抑制药物是他克莫司。辅助性诱导和多种药物治疗(聘用ERA 11(1/95-6/01)。III期(7/01-11/08)接受他克莫司单一治疗。在II/III期，供者骨髓移植(n=-79)，肠外照射(n=44)，监测EB病毒(EBV)/巨细胞病毒(CMV)导联。61%(5年)。10年期利率为42%。15年时为35%，移植物存活率分别为80%。50%。33%。29%。再移植率为10%。术后1年存活率为69%，5年存活率为47%，以同种异体肠肝移植效果最好。兔抗胸腺细胞球蛋白或阿仑珠单抗预处理可显著改善移植效果(P<；0.001)，术后1年和5年存活率分别为92%和70%。结论：随着管理策略的发展，存活率有了很大的提高，目前的结果清楚地证明了将手术水平提升到其他腹部器官的水平是合理的，同时有特权永久驻留在外科腋下的一个受人尊敬的位置。仍然需要创新的策略来克服长期的风险，如无肝移植的慢性排斥反应和多脏器受者的感染。
Objective: To assess the evolution of visceral transplantation In the milieu Of surgical technical modifications. new immunosuppressive protocols, and other management strategiesSummary Background Data: With the clinical feasibility of Intestinal and multivisceral transplantation in 1990. multifaceted innovative tactics Were required to improve outcome and Increase procedural practicalityMethods: Divided into 3 eras. 453 patients received 500 visceral transplants The primary used immunosuppression Was tacrolimus-steroid-only during Era 1 (5/90-5/94). adjunct induction with multiple drug therapy (hiring Era 11 (1/95-6/01). and recipient pretreatment with tacrolimus monotherapy during Era III (7/01-11/08) During Era II/III, donor bone marrow was given (n =- 79) intestine was ex vivo Irradiated (n = 44), and Epstein-Barr-Virus (EBV)/cytomegalovirus (CMV) leads were monitoredResults: Actuarial patient survival was 85% at 1-year. 61% at (5-years. 42% at 10-years. and 35% at 15-years with respective graft survival of 80%. 50%. 33%. and 29%. With a 10% retransplantation rate. second/third graft survival was 69% at 1-year and 47% at 5-years The best outcome was with intestine-liver allografts Era III rabbit antithymocyte globulin or alemtuzumab pretreatment-based strategy was associated with significant (P < 0.001) improvement in outcome with 1- and 5-year patient survival of 92% and 70%Conclusion: Survival has greatly improved over time as management strategies evolved The current results clearly justify elevating the procedure level to that of other abdominal organs With the privilege to permanently reside in a respected place in the surgical armamentarum U III Meanwhile. innovative tactics are still required to conquer long long-term hazards of chronic rejection of liver-free allografts and infection of multivisceral recipients.