McGowan Institute for Regenerative Medicine
faculty members Adriana Zeevi, Ph.D. (pictured top), professor of pathology and surgery at the University of Pittsburgh Medical Center (UPMC), Abhinav Humar, M.D. (pictured center), chief of transplantation, staff physician, and professor in the department of surgery at UPMC, and George Mazariegos, M.D. (pictured bottom), pediatric liver and intestine transplant surgeon at Children’s Hospital of Pittsburgh of UPMC and the Thomas E. Starzl Transplantation Institute, are co-authors on a study recently published which assessed the evolution of intestinal and multivisceral transplantation. The data, from the largest single-center experience of adult and pediatric intestinal and multivisceral transplantation, show that survival rates have improved with the advent of innovative surgical techniques, novel immunosuppressive protocols, and better post-operative management. The researcher team reported on the first 500 intestinal and multivisceral transplants conducted at the UPMC from 1990 to 2008, which represent more than 25 percent of the worldwide experience.
Over nearly 2 decades divided into 3 eras, 453 patients received 215 intestine, 151 liver-intestine, and 134 multivisceral transplants. Some of these patients are the longest surviving intestinal and multivisceral transplant recipients in the world, surviving more than 19 years post-transplant with excellent quality of life.
During what the researchers dubbed Era I (1990 to 1994), transplant recipients were treated with the immunosuppressive drug tacrolimus and steroids. In 1994, this protocol was discontinued due to high mortality and morbidity rates. The 5-year survival rate for these patients was 40 percent.
Era II (1995 to 2001) introduced the use of donor bone marrow to encourage organ acceptance. The 5-year survival rate for these patients was 56 percent.
During Era III (2001 to 2008), patients were given a pre-conditioning protocol with agents that deplete recipients’ own immune calls. Their post-transplant drug regimen was minimal and was initiated with tacrolimus, followed by steroids when necessary. Tacrolimus doses were subsequently spaced to a single dose twice to three times per week with a careful weaning process that started 3 to 6 months after transplant. Through the use of new immunosuppressive and management strategies, the 5-year survival rate for these patients increased to 68 percent, which is similar to any other abdominal and thoracic organ transplant procedure.
“The findings support the minimization of immunosuppressive therapy for intestinal and multivisceral transplant patients,” said lead researcher Kareem Abu-Elmagd, M.D., Ph.D., director, Intestinal Rehabilitation and Transplantation Center, Thomas E. Starzl Transplantation Institute, and professor of surgery, University of Pittsburgh School of Medicine. “Our research found that survival rates for such transplant recipients greatly increased as treatment strategies evolved; this included the reduction in the use of immunosuppressive therapy.”
Illustration: McGowan Institute for Regenerative Medicine.
University of Pittsburgh Schools of the Health Sciences Media Relations News Release (10/05/09)
Science Daily (10/06/09)
Medical News Today (10/07/09)
Bio: Dr. Adriana Zeevi
Bio: Dr. Abhinav Humar
Bio: Dr. George Mazariegos
Abstract (Annals of Surgery: October 2009, Volume 250, Issue 4, pp 567-581)