In addition, these modifications have significantly improved survival for patients transplanted in the last four years, for whom there is a cumulative 65 percent survival rate. Thirty-five patients are alive and able to maintain good nutrition for more than three years, and 22 are beyond the five-year milestone. One patient who received a small bowel and liver has survived nearly nine years.
In the last year, since adding the drug daclizumab to the anti-rejection drug regimen, surgeons have been able to achieve a 92 percent one-year survival, reported Dr. Abu-Elmagd. The results are based on 14 patients.
Overall, those who had the best results were children with microvillis disease, a hereditary intestinal disease, or gastrochisis, a congenital condition that causes the intestine to die. Among adults, those with the best results had a diagnosis of Crohn's disease or a condition that involves severe clotting of the main vessels leading to the intestine.
Patients with intestinal failure must be sustained nutritionally with intravenous feedings called total parenteral nutrition (TPN). Liver failure often results after long-term use of TPN, hence the need for a life-saving combined liver and intestine transplant in some patients. But as a preventive measure against the likelihood of liver failure and to improve the quality of life for patients who still have the option of TPN, a transplant of the small intestine is a more cost-effective alternative.
According to 1992 Medicare figures, TPN's annual price tag is $150,000, a conservative figure that does not include associated costs for medical equipment, nursing home-health care and frequent hospitalizations. Today's costs are believed to be much higher.
"Based on these data, intestinal transplantation becomes cost-effective by the
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Contact: Lisa Rossi
rossiL@msx.upmc.edu
412-624-2607
University of Pittsburgh Medical Center
18-May-1999