Inclusion of donor colon and ileocecal valve in intestinal transplantation

BACKGROUND.: Evaluation of the clinical impact of including donor colon and ileocecal valve in patients receiving primary intestinal transplantation has not been performed in a sufficiently large series of cases. METHODS.: Cox stepwise regression of overall and cause-specific graft survival was performed to evaluate the clinical impact of including donor colon in our single center cohort of 245 consecutive primary intestinal transplant recipients, among which 93 received a donor colon. RESULTS.: Inclusion of donor colon had no significant impact on overall graft survival in either univariable (P=0.13) or multivariable (P=0.45) analysis, nor on the hazard rates of death caused by infection and graft loss because of other causes (NS). Although inclusion of colon was associated in univariable analysis (P=0.02) with a significantly lower hazard rate of graft loss because of rejection, this effect was no longer significant once its association with the stronger predictor "receipt of multivisceral transplant" was controlled (P=0.23). However, in a subset analysis of multivisceral transplanted patients since 2003, a favorable impact of including the donor colon on graft survival was observed (P=0.04). Lastly, children who received donor colon recipients had a significantly higher percentage of formed stools after stoma closure (P=0.001). CONCLUSIONS.: Our results with a relatively large number of patients receiving a donor colon suggest that this procedure carries no obvious additional morbidity or mortality risk, particularly with respect to graft survival. Inclusion of donor colon should actively be considered for intestinal transplant recipients.