Short and Long term function and Short and Long term function and survival of other graft harvested as survival of other graft harvested as part of a multiorgan procurement part of a multiorgan procurement

including the intestineincluding the intestine

Farinelli P, Troncoso J, Bertolotti A, Lenz M, Sanchez N, Fortunato R, Caravello E, Imperiali N, Dip M, Sanchez Claria R, Arriola M, De Arteaga J, Pujol Soler G, Gil O, Mc Cormack L, Bota E, Inventarza O, Gaite L, Hyon S H, Raffaele P, Illanes G, de Santibañez E, Favaloro R, Bisigniano

L, Gondolesi G.

The use of Thymoglobulin donor pre-treatment has become standard of practice in most of the intestinal transplant programs

The reported aim has been to reduce the incidence of post-transplant GVHD

The introduction of this practice in different countries and as part of the development of new programs requires an adequate understanding and organization among all the teams involved in the procurement

Introduction & Objectives

AIM: Report short and long term outcomes of other graft harvested as part of the Multiorgan Procurements

including the intestine in our country

Materials & Methods

Retrospective multicentre studyMultiorgan Procurements including the intestines From March 2006 to July 2011

INCUCAI web page Donors and centres data from Argentina Data Survey sent to all programs:

Graft survivalRecipient survivalPrimary graft dysfunction (PGD)Delay Graft Function (DGF)Organ specific laboratory values:

liver recipients: serum bilirubin and transaminase levelskidney-pancreas recipients: serum lipase, amylase and creatinine levelskidney recipients: creatinine levelsintestine recipients: full enteric nutritional autonomy time

Materials & Methods

The logistics and techniques for multiple organ procurement were used according to previous publications (Starzl et al, 1984, 1987, 1991; Abu-Elmagd et al, 2000)

Donors: * Pre-treated - Metil-Prednisolone (1 gr in adults/20 mg/kg in childrens)

- Thymoglobulin (1.5 mg/kg)* Selective gut decontamination was given for procurement of the intestine and

the pancreas

University of Wisconsin (UW) solution was used for in situ flushing and cold storage for all organs but the kidney (HTK)

Prospective cross-match was performed for all the intestinal transplant recipients

Retrospective cross-match and Human Leukocyte Antigen matching with the recipients was used for heart, pancreas and kidney transplants.

Results

127/129 organs from 29 Multiorgan Procurements (19 Children and 10 Adults) were engrafted - 101 patients transplanted - 29 transplant programs at 18 hospitals nationwide (24/29 answered the survey)

5 Intra-thoracic transplantation programs12 Hearts 2 Lungs 1 Cardio-Pulmonary Block

19 Abdominal transplantation programs19 livers 9 kidney-pancreas19 Kidneys29 Intestines (22 isolated, 5 multivisceral and 2 combined)

Organ Patients PGD Recovered Organ Survival Patient Survival

Heart 12 4/12 (33.3%) 1/4 (25%) 9/12 (75.0%) 9/12 (75.0%)

Lung 2 0 (0%) 0 (0%) 2/2 (100.0%) 2/2 (100.0%)

CP Block 1 1 (100%) 0 (0%) 0/1 (0.0%) 0/1 (0.0%)

ResultsIntra-thoracic transplantation programs

PGD

4/12 (33.3%)

0 (0%)

1 (100%)

Recovered

1/4 (25%)

0 (0%)

0 (0%)

Organ SurvivalPatient Survival

9/12 (75.0%) 9/12 (75.0%)

2/2 (100.0%) 2/2 (100.0%)

0/1 (0.0%) 0/1 (0.0%)

ResultsAbdominal transplantation programs

Organ Tx PGD DGF Organ SurvivalPatient Survival

Kidney 19 1/19 (5.26%) 4/19 (21.1%) 17/19 (89.5%) 18/19 (94.7%)

Kidney-Pancreas 9

Kydney 9 0 (0.0%) 3/9 (33.3%)* 7/9 (78.0%) 7/9 (78.0%)

Pancreas 9 3/9 (33.3%)* 0 (0.0%) 6/9 (66.7%) 7/9 (78.0%)

Liver 19

Splits 4 0 (0.0%) 0 (0.0%) 4/4 (100.0%) 4/4 (100.0%)

Whole 15 0 (0.0%) 0 (0.0%) 12/15 (80.0%) 12/15 (80.0%)

Time post TxTotal Bilirubin

(mg/dL)ALT

(IU/L)AST(IU/L)

24 Hs 8.20±5.12 2378±2975 1250±1207

1 Week 6.54±7.19 69.78±61.09 150.60±263.60

1 Month 1.48±0.70 30.00±13.19 38.94±24.62

0 (0.0%) 0 (0.0%)

0 (0.0%) 0 (0.0%)

4/4 (100.0%) 4/4 (100.0%)

12/15 (80.0%) 12/15 (80.0%)

ResultsAbdominal transplantation programs

Organ Tx PGD DGF Organ SurvivalPatient Survival

Kidney 19 1/19 (5.26%) 4/19 (21.1%) 17/19 (89.5%) 18/19 (94.7%)

Kidney-Pancreas 9

Kydney 9 0 (0.0%) 3/9 (33.3%)* 7/9 (78.0%) 7/9 (78.0%)

Pancreas 9 3/9 (33.3%)* 0 (0.0%) 6/9 (66.7%) 7/9 (78.0%)

Liver 19

Splits 4 0 (0.0%) 0 (0.0%) 4/4 (100.0%) 4/4 (100.0%)

Whole 15 0 (0.0%) 0 (0.0%) 12/15 (80.0%) 12/15 (80.0%)

Time post TxAmylase

(IU/L)Lipase(IU/L)

Creatinine(mg/dL)

48 Hs 252±134 253±199 5.89±3.83

1 Week 132±82 304±348 2.01±2.75

1 Month 100±52 88±59 1.20±0.45

0 (0.0%) 3/9 (33.3%)*

3/9 (33.3%)* 0 (0.0%)

7/9 (78.0%) 7/9 (78.0%)

6/9 (66.7%) 7/9 (78.0%)

ResultsAbdominal transplantation programs

Organ Tx PGD DGF Organ SurvivalPatient Survival

Kidney 19 1/19 (5.26%) 4/19 (21.1%) 17/19 (89.5%) 18/19 (94.7%)

Kidney-Pancreas 9

Kydney 9 0 (0.0%) 3/9 (33.3%)* 7/9 (78.0%) 7/9 (78.0%)

Pancreas 9 3/9 (33.3%)* 0 (0.0%) 6/9 (66.7%) 7/9 (78.0%)

Liver 19

Splits 4 0 (0.0%) 0 (0.0%) 4/4 (100.0%) 4/4 (100.0%)

Whole 15 0 (0.0%) 0 (0.0%) 12/15 (80.0%) 12/15 (80.0%)

1/19 (5.26%) 4/19 (21.1%) 17/19 (89.5%) 18/19 (94.7%)

Time post TxCreatinine

(mg/dL)

48 Hs 6.79±2.60

1 Week 4.19±2.74

1 Month 1.25±0.59

1 Year 1.04±0.30

Conclusions

Organs harvested during MTOp including the Organs harvested during MTOp including the intestine can be safely usedintestine can be safely used

In spite of needing longer time and team efforts, In spite of needing longer time and team efforts, short and long term graft and patient survivals short and long term graft and patient survivals seem to be better of those obtained in regular seem to be better of those obtained in regular

procurements without the intestines and procurements without the intestines and reported by national and international seriesreported by national and international series

Thank you very much!Thank you very much!