Transplant effective in treating those with severe Crohn's disease, study shows
(Medical Xpress)—Patients suffering from severe Crohn's disease who were no longer able to tolerate intravenous feedings were able to return to a normal oral diet and saw no clinical recurrences of the disease after undergoing intestinal or multivisceral transplants, according to a study of cases performed at UPMC over more than 20 years.
The study is the largest of its kind examining the efficacy of transplant in patients with end-stage Crohn's disease. It was presented at the 2012 Advances in Inflammatory Bowel Diseases, the clinical and research conference of the Crohn's and Colitis Foundation, in Hollywood, Fla., on Dec. 15.
"Intestinal transplantation was developed here at UPMC, and, as international leaders in this specialized surgery, we have a wealth of data that other centers don't," said Guilherme Costa, M.D., interim director, UPMC Intestinal Rehabilitation and Transplantation Center, who presented the study. "What that data show us is that intestinal and multivisceral transplant works to save the lives of those patients suffering from the most severe symptoms of Crohn's disease."
Crohn's is a chronic bowel disease that can cause inflammation, ulcers and bleeding in the digestive tract. Patients suffering from a severe form of the disease often have irreversible intestinal failure and sometimes need to receive nutrition through a tube inserted into a vein, known as total perenteral nutrition (TPN). Patients unable to tolerate TPN are often referred for an intestinal transplant.
In the study, UPMC researchers looked at 309 adult patients who received intestinal and multivisceral transplants between 1990 and June 2012. Of these, 57 had Crohn's disease with irreversible intestinal failure, and all had failed TPN therapy with multiple line infections. Twenty-one percent, or 12, of these patients also required a liver transplant because they suffered from end-stage liver failure; 43 had just an intestinal transplant; and two patients had a modified multivisceral graft that included the stomach, duodenum, pancreas and intestine.
The study found the patient survival rate was 90 percent at one year, 74 percent at three years, 56 percent at five years, and 43 percent at 10 years. Inclusion of the donor liver was associated with better long-term survival outcome with a 10-year survival rate of 57 percent. All survivors achieved full nutritional autonomy, enjoying an unrestricted oral diet after transplant.
"The success we've seen in our patients is an indicator that transplant offers real hope to Crohn's patients who have been debilitated by this disease," Dr. Costa said.
