Introduction: Intestinal transplantation (ITx) is indicated when life-threatening complications occur following chronic total parenteral nutrition in intestinal failure patients. Several complications (TPN related irreversible liver disease or diffuse splanchnic thrombosis) require simultaneous transplantation of the liver (and sometimes additional viscera). ITx has long been considered as the most difficult organ to transplant due to a high risk of rejection and sepsis. The liver may facilitate engraftment and protect against rejection But on the other hand, addition of the liver complicates the surgical procedure and exposes recipients to more risks. Inclusion of the liver in ITx candidates with milder forms of liver disease (to protect the intestinal graft) is controversial. Aim: To investigate the effect of the inclusion of a liver graft on outcome after ITx. Methods: We performed a retrospective analysis on our database of ITx recipients, containing recipients of either liver free grafts (LFG) or liver containing grafts (LCG). The data was analyzed on the basis of clinical outcomes, rejection, and survival. We only included patients who received a cadaveric graft. Results: From 2000 onwards, 15 patients with irreversible intestinal failure received an ITx at our center. Of these, 9 received a LCG and 6 a LFG. 3 were pediatric patients and 12 adults. All received their grafts from brain dead donors that had a negative cross-match. HLA matching was at random. 12 patients (80%) are alive and 11 of these are TPN-independent at home. 1 patient lost her intestinal graft after a biopsy. There were 3 patient deaths: 2 in LCG recipients and 1 in LFG recipient. The 5 year patient survival for LCG and LFG was 88.8% and 83.3% respectively. 5 year graft survival was 88.8% in LCG and 62.3% in LFG. 33% of LCG patients experienced acute rejection against 50% of LFG patients. No chronic rejection was observed. All rejections could be treated by additional immunosuppression. No grafts were lost due to rejection or infection. No donor specific antibodies were detected in any patients. Conclusions: Addition of the liver to an intestinal graft did not lead to poorer results. On the contrary, there was a trend for less rejection and better graft survival when the liver was co-transplanted. Both liver containing and liver-free ITx represent lifesaving procedures with excellent outcomes.

CITATION INFORMATION: Canovai E, Monbaliu D, Jochmans I, Sainz Barriga M, Ceulemans L, De Hertogh G, Pirenne J. Influence of Inclusion of the Liver on the Outcome After Intestinal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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