Intestinal Transplantation for Trauma Patients S. Nishida, T. Kato, D. Levi, J. Nery, J. Madariaga, N. Mittal, D. Weppler, J. Tector, P. Rutz, and A. Tzakis T OTAL PARENTERAL nutrition (TPN) is the treat- ment of choice for patients with intestinal failure. Intestinal and multivisceral transplantation provides the lifesaving alternative for those patients who develop life- threatening complications of TPN. 1 Recent advances in intestinal transplantation have paved the way for significant improvements in patient and graft survival. 2 Trauma involv- ing the superior mesenteric artery or vein is one of the most common causes of short bowel syndrome in adults. These cases usually result from severe trauma involving other organs. These patients are more critically ill than other intestinal failure patients. The purpose of the study was to describe the clinical and surgical feature of intestinal trans- plantation for trauma patients. PATIENTS AND METHODS This is a retrospective review of the five intestinal transplants for trauma patients among a series of 43 intestinal transplants per- formed in adults between December 1994 and March 2001 at the University of Miami/Jackson Memorial Medical Center. Results are reported as mean  SD. Patient and graft survival estimates were obtained using the Kaplan-Meier product limit method. RESULTS All five were male patients of mean age of 26.6  2.63 years old. The cause of short bowel syndrome was a motor vehicle accident in three patients and gunshot wounds in two patients. Three of five patients had total parenteral nutri- tion induced cholestatic liver failure. All five patients had multiple pretransplant abdominal operations (bowel resec- tion in five patients, colectomy in three patients, cholecys- tectomy in two patients, and pancreaticoduodenectomy in one patient) and complications (cholestatic liver failure in three patients; pancreatitis in three patients; abdominal abscess in three patients; open wound in two patients; liver, duodenum, and inferior cava injury in one patient; deep vein thrombosis in one patient; and pancreas fistula in one patient). Isolated intestinal transplantation was performed in one patient (20%). Multivisceral transplantation was performed in four patients (80%). All five cases were difficult transplant procedures due to previous etiologies. Three patients had a frozen abdomen, and the abdominal cavities were very small in all five patients. The abdomen was closed using mesh in three patients and a skin flap in two patients. Mean cold ischemia time was 308 minutes  102 and the mean warm ischemic time was 35  3.0 minute. All five patients have experienced acute rejection of their small bowel grafts. Severe rejection led to graft failure in one patient. Two patients died postoperatively (POD53, POD91) and three patients survive at present (348 to 1452 days). The causes of death were viral encephalitis (n  1) and sepsis after severe rejection (n  1). The 3-year patient and graft survivals were 60% and 60%, respectively. The three surviving patients no longer require total parenteral nutrition. CONCLUSIONS Intestinal transplantation is a lifesaving alternative for patients with intestinal failure due to trauma. Trauma patients are more likely to be sicker and more complicated. Intestinal transplantation for trauma patients is a techni- cally more difficult procedure. Multivisceral transplantation tends to be performed because of the multiorgan nature of their injuries. REFERENCES 1. Grant D: Transplantation 67: 1061, 1999 2. Kato T, Nishida S, Mittal N, et al: Transplant Proc 34:(this issue), 2002 From the University of Miami School of Medicine, Miami, Florida, USA. Address reprint requests to Seigo Nishida, MD, University of Miami School of Medicine, Department of Surgery, 1801 NW 9th Avenue 5th floor, Miami, FL 33136. © 2002 by Elsevier Science Inc. 0041-1345/02/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(02)02666-0 Transplantation Proceedings, 34, 913 (2002) 913