Combined Liver, Small Bowel, Pancreas and Kidney Transplantation (LSBPKTx): Single Center Experience of over a Decade

L. Bathla, W. Grant, D. Mercer, L. Vargas, A. Langnas

Surgery, University of Nebraska Medical Center, Omaha, NE

Meeting: 2013 American Transplant Congress

Abstract number: 127

Background

Combined liver, small bowel and pancreas transplantation (LSBPTx) is a well established treatment for patients with intestinal failure and associated liver disease. Some of these patients have chronic renal insufficiency or end stage renal disease (ESRD). These patients are candidates for LSBPKTx instead of LSBPTx. In the last 25 years, only 79 LSBPKTx have been reported in the UNOS database. The objective of this review is to evaluate the clinical outcomes of LSBPKTx done at our center over the last 11 years

Methods

An outcome analysis was performed from the prospective database on patients undergoing LSBPKTx at our center from May 2000 to Nov 2012. Demographic, peri-operative, and long-term follow-up data were analyzed.

Results

A total of 8 such transplants were performed in 7 patients at our center. Seven of these transplants were en bloc. The median age at the time of transplant was 8.8 years and median donor to recipient weight ratio was 0.56. The median donor age was 39 months. The median cold ischemia time for the allograft was 550 minutes. The median length of stay and ICU length of stay was 65 days and 18 days (range 7-92 days) respectively. Median additional abdominal operative procedures performed during the hospital stay were 2 (range 0-10). Most common ureteric anastomosis was uretero-neocystostomy (4/8). Pertinent patient data has been summarized as shown.

Pertinent Patient Characteristics
Patient Number	Age at Transplant in Years	Follow Up in Months	Donor Age in Months	Donor Recipient Weight Ratio	Cold Ischemia Time in Minutes	Length of Stay	Creatinine at Last Follow UP
1	32.2	150	96	0.45	609	146	1.16
2	12.6	67	89	0.86	367	33	0.5
3	5	59	18	0.37	669	35	0.37
4	37.5	8*	91	0.58	634	147	0.9
5	2.6	39	9	0.53	524	71	0.25
6	3.7	3*	1	0.27	577	92	0.44
6	3.9	13*	12	0.57	419	60	0.44
7	14	1	60	0.56	473	44	0.7

*: Deceased patients

There was no peri-operative mortality. The median duration of follow-up was 26 months (range 1-150 months). There was one episode of rejection of the small bowel allograft in the entire cohort. One of the en bloc kidneys was explanted secondary to torsion. One ureteral revision was performed for reflux. There was one graft loss which required re-transplantation. There were two deaths secondary to PTLD and sepsis respectively.

Conclusions

LSBPKTx can be performed with good outcomes in patients with chronic renal insufficiency or ESRD who are otherwise candidates for LSBPTx.

To cite this abstract in AMA style:

Bathla L, Grant W, Mercer D, Vargas L, Langnas A. Combined Liver, Small Bowel, Pancreas and Kidney Transplantation (LSBPKTx): Single Center Experience of over a Decade [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/combined-liver-small-bowel-pancreas-and-kidney-transplantation-lsbpktx-single-center-experience-of-over-a-decade/. Accessed November 22, 2024.

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