Short and Long term function and survival of other graft harvested as part of a multiorgan procurement including the intestine Farinelli P, Troncoso J,

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Short and Long term function and survival of other graft harvested as part of a multiorgan procurement including the intestine Farinelli P, Troncoso J, Bertolotti A, Lenz M, Sanchez N, Fortunato R, Caravello E, Imperiali N, Dip M, Sanchez Claria R, Arriola M, De Arteaga J, Pujol Soler G, Gil O, Mc Cormack L, Bota E, Inventarza O, Gaite L, Hyon S H, Raffaele P, Illanes G, de Santibañez E, Favaloro R, Bisigniano L, Gondolesi G.

 The use of Thymoglobulin donor pre-treatment has become standard of practice in most of the intestinal transplant programs  The reported aim has been to reduce the incidence of post-transplant GVHD  The introduction of this practice in different countries and as part of the development of new programs requires an adequate understanding and organization among all the teams involved in the procurement Introduction & Objectives AIM: Report short and long term outcomes of other graft harvested as part of the Multiorgan Procurements including the intestine in our country

Materials & Methods Retrospective multicentre study Multiorgan Procurements including the intestines From March 2006 to July 2011  INCUCAI web page Donors and centres data from Argentina  Data Survey sent to all programs: Graft survival Recipient survival Primary graft dysfunction (PGD) Delay Graft Function (DGF) Organ specific laboratory values: liver recipients: serum bilirubin and transaminase levels kidney-pancreas recipients: serum lipase, amylase and creatinine levels kidney recipients: creatinine levels intestine recipients: full enteric nutritional autonomy time

Materials & Methods  The logistics and techniques for multiple organ procurement were used according to previous publications (Starzl et al, 1984, 1987, 1991; Abu-Elmagd et al, 2000)  Donors: * Pre-treated - Metil-Prednisolone (1 gr in adults/20 mg/kg in childrens) - Thymoglobulin (1.5 mg/kg) * Selective gut decontamination was given for procurement of the intestine and the pancreas  University of Wisconsin (UW) solution was used for in situ flushing and cold storage for all organs but the kidney (HTK)  Prospective cross-match was performed for all the intestinal transplant recipients  Retrospective cross-match and Human Leukocyte Antigen matching with the recipients was used for heart, pancreas and kidney transplants.

Results 127/129 organs from 29 Multiorgan Procurements (19 Children and 10 Adults) were engrafted patients transplanted - 29 transplant programs at 18 hospitals nationwide (24/29 answered the survey)  5 Intra-thoracic transplantation programs 12 Hearts 2 Lungs 1 Cardio-Pulmonary Block  19 Abdominal transplantation programs 19 livers 9 kidney-pancreas 19 Kidneys 29 Intestines (22 isolated, 5 multivisceral and 2 combined)

OrganPatientsPGDRecoveredOrgan SurvivalPatient Survival Heart124/12 (33.3%)1/4 (25%)9/12 (75.0%) Lung20 (0%) 2/2 (100.0%) CP Block11 (100%)0 (0%)0/1 (0.0%) Results Intra-thoracic transplantation programs PGD 4/12 (33.3%) 0 (0%) 1 (100%) Recovered 1/4 (25%) 0 (0%) Organ Survival Patient Survival 9/12 (75.0%) 2/2 (100.0%) 0/1 (0.0%)

Results Abdominal transplantation programs OrganTxPGDDGFOrgan SurvivalPatient Survival Kidney191/19 (5.26%)4/19 (21.1%)17/19 (89.5%)18/19 (94.7%) Kidney-Pancreas9 Kydney90 (0.0%)3/9 (33.3%)*7/9 (78.0%) Pancreas93/9 (33.3%)*0 (0.0%)6/9 (66.7%)7/9 (78.0%) Liver19 Splits40 (0.0%) 4/4 (100.0%) Whole150 (0.0%) 12/15 (80.0%) Time post Tx Total Bilirubin (mg/dL) ALT (IU/L) AST (IU/L) 24 Hs 8.20± ± ± Week 6.54± ± ± Month 1.48± ± ± (0.0%) 4/4 (100.0%) 12/15 (80.0%)

Results Abdominal transplantation programs OrganTxPGDDGFOrgan SurvivalPatient Survival Kidney191/19 (5.26%)4/19 (21.1%)17/19 (89.5%)18/19 (94.7%) Kidney-Pancreas9 Kydney90 (0.0%)3/9 (33.3%)*7/9 (78.0%) Pancreas93/9 (33.3%)*0 (0.0%)6/9 (66.7%)7/9 (78.0%) Liver19 Splits40 (0.0%) 4/4 (100.0%) Whole150 (0.0%) 12/15 (80.0%) Time post Tx Amylase (IU/L) Lipase (IU/L) Creatinine (mg/dL) 48 Hs 252±134253± ± Week 132±82304± ± Month 100±5288±591.20± (0.0%)3/9 (33.3%)* 0 (0.0%) 7/9 (78.0%) 6/9 (66.7%)7/9 (78.0%)

Results Abdominal transplantation programs OrganTxPGDDGFOrgan SurvivalPatient Survival Kidney191/19 (5.26%)4/19 (21.1%)17/19 (89.5%)18/19 (94.7%) Kidney-Pancreas9 Kydney90 (0.0%)3/9 (33.3%)*7/9 (78.0%) Pancreas93/9 (33.3%)*0 (0.0%)6/9 (66.7%)7/9 (78.0%) Liver19 Splits40 (0.0%) 4/4 (100.0%) Whole150 (0.0%) 12/15 (80.0%) 1/19 (5.26%)4/19 (21.1%)17/19 (89.5%)18/19 (94.7%) Time post Tx Creatinine (mg/dL) 48 Hs 6.79± Week 4.19± Month 1.25± Year 1.04±0.30

Conclusions Organs harvested during MTOp including the intestine can be safely used In spite of needing longer time and team efforts, short and long term graft and patient survivals seem to be better of those obtained in regular procurements without the intestines and reported by national and international series

Thank you very much!