Background: Living donor intestinal transplant (LDITx) has not been routinely performed yet because of surgical risks to the donor and the potential inferior physiologic performance of the segmental graft. However, data on the effectiveness of LDITx are scarce. In this report, we update clinical outcomes and complications of both the recipient and the living donor after LDITx in our program over two decades of experience.
Methods: This retrospective cohort study included patients undergoing LDITx between May 1999 and November 2023 in intestinal transplant programs at two university-affiliated hospitals in China.
Results: Fifty-four patients underwent LDITx consecutively. Thirty-three were adults and twenty-one were children. There were thirteen deaths among the recipients, with infection being the leading cause (46.2%), followed by rejection (30.8%), surgical complications (15.4%), and others (7.7%). There were eighteen graft losses among the recipients, with acute cellular rejection being the predominant cause (33.3%), followed by infection (27.8%), technical failure (11.1%), chronic rejection (16.7%), and others (11.1%). With an average follow-up of 3.2 (range, 0.2–24.7) years, the rates of acute and chronic rejection were 25.9% and 5.6%, and the rate of CMV disease and PTLD were 5.6% and 3.7%, respectively. Recipients with > 3/6 HLA-matched grafts had superior patient and graft survival rates than those with ≤ 3/6 HLA-matched grafts (P < 0.05). The Kaplan-Meier estimates for overall survival rates were 84.2%, 74.5%, 68.6% for patient and 80.7%, 68.3%, 64.2% for graft at 1, 3, and 5 years, respectively. Currently, 41/54 (75.9%) are alive and have achieved enteral autonomy. Among the fifty-four living donors, none experienced life-threatening complications or mortality and 6/54 (11.1%) experienced minor operative complications. Temporary intestinal inadequacy including diarrhea, weight loss, and vitamin B12 deficiency was common early following surgery, but was manageable and disappeared in most cases within a year. All the donors have regained their normal capacity for work.
Conclusions: LDITx is a valuable treatment option for patients with end-stage intestinal failure and is associated with reduced rates of rejection, viral-mediated infection and thus improved patient and graft survival.