Disease Recurrence After Intestinal and Multivisceral Transplantation

Introduction: Similar to other organ and cell transplantation, visceral allograft recipients are at risk for disease recurrence. This single center experience addresses the risk of disease recurrence in both the allograft and extra-gastrointestinal systems in patients who underwent transplant due to a potentially recurrent disorder. Methods: The database of a total of 78 patients with potentially recurring disease including thrombophilia (n= 29), global gut dysmotility (n=24), Crohn’s disease (n=18), and gastrointestinal neoplastic disorders (n=7) were reviewed and analyzed. Of these, 53 were transplanted at Cleveland Clinic and 25 were transplanted elsewhere. All patients were adults with 63% female. The visceral allografts were isolated intestine (n=52), liver/intestine (n=6), modified multi-visceral (n=11), and full multi-visceral (n=9). All patients were disease free at the time of transplant, with the exception of the thrombophilic patients who were fully anticoagulated. The diagnosis of disease recurrence was established based on clinical, hematologic, radiologic, and histopathologic studies. Results: With a mean follow-up of 80 ± 75 months from the transplant date, 7 patients developed disease recurrence with an overall incidence of 9% in this cross-sectional study. The risk of disease recurrence was higher with global dysmotility (17%) compared to thrombophilia (10%) and Crohn’s (6%). The 4 transplant recipients (3 isolated and 1 modified multivisceral) with gut dysmotility recurrence had no evidence of mechanical obstruction, or allograft rejection. None of the gastrointestinal neoplastic disorder recipients developed de novo disease or recurrence. The hypercoagulable patients developed recurrent vascular thrombosis in the extra allograft vascular system, with the exception of one patient who developed a nonocclusive Carrel patch clot. Recurrent Crohn’s was a histologic diagnosis based on identification of granulomas in surveillance biopsies. None of the recipients with disease recurrence lost the allograft or required retransplantation except two of the gut dysmotility recipients who underwent successful retransplantation. Conclusions: Disease recurrence is a potential risk after intestinal and multivisceral transplantation with no significant impact on outcome. Longitudinal follow-up is required to determine the long-term impact on allograft function and quality of life.