Autologous Microfragmented Adipose Tissue Injection in Refractory Complex Crohn's Perianal Fistulas: Long-Term Results at 6.7 Years Mean Follow-up

Silvio Laureti; Alberta Cappelli; Claudio Isopi; Lorenzo Gentilini; Riccardo Villani; Gioia Sorbi; Fernando Rizzello; Alessandra Menon; Nikolas Konstantine Dussias; Paolo Gionchetti; Gilberto Poggioli

doi:10.1093/ibd/izae283

Autologous Microfragmented Adipose Tissue Injection in Refractory Complex Crohn's Perianal Fistulas: Long-Term Results at 6.7 Years Mean Follow-up

Inflamm Bowel Dis. 2024 Dec 5:izae283. doi: 10.1093/ibd/izae283. Online ahead of print.

Affiliations

¹ Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS S. Orsola-Malpighi Hospital, DIMEC, University of Bologna, Bologna, Italy.
² Department of Medical and Surgical Sciences, Radiology Unit, IRCCS S. Orsola-Malpighi Hospital, DIMEC, University of Bologna, Bologna, Italy.
³ Department of Medical and Surgical Sciences, Plastic and Reconstructive Surgery Unit, IRCCS S. Orsola-Malpighi Hospital, DIMEC, University of Bologna, Italy.
⁴ Department of Medical and Surgical Sciences, IBD Unit, IRCCS S. Orsola-Malpighi Hospital, DIMEC, University of Bologna, Bologna, Italy.
⁵ U.O.C 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy.

PMID: 39657028
DOI: 10.1093/ibd/izae283

Abstract

Background: Nowadays, there is a clear need for new viable therapeutic options to face complex perianal Crohn's disease (PCD). Results of our previous pilot study demonstrated the efficacy and safety of local injection of autologous microfragmented adipose tissue (MFat) in this setting. This study aims to evaluate the long-term follow-up results in the same cohort of patients.

Methods: Data on clinical and radiological remission and surgical recurrence rates were prospectively collected on the 15 patients with complex fistulizing PCD refractory to combined bio-surgical therapy, originally treated with local MFat injection, with a mean 6.7 years follow-up.

Results: In our previous study, at 24-week follow-up, combined remission was reported in 66.7% of patients, while clinical remission was achieved in 93% of cases. At a 6.7-year follow-up, 9 of the 10 healed patients maintained remission. The patient with recurrence was successfully reoperated. Three out of 5 patients who failed primary combined remission were retreated, with 2 obtaining combined remission and 1 failing. One patient refused any subsequent treatment due to good quality of life. The last patient presented delayed healing at a 1-year follow-up. Overall success rate after rescue therapy at the final follow-up reached 86.6%. Safety was maintained throughout all follow-up periods.

Conclusions: This is the longest follow-up published trial on MFat injection for PCD. Our results show that patients who achieved closure in the first 24 weeks sustained response at long-term evaluation. In addition, there may be a rationale in repeating treatment as rescue therapy in not responding to patients.

Keywords: Lipogems; autologous microfragmented adipose tissue transplant; complex perianal fistulas; fistulectomy; perianal Crohn’s disease.

Plain language summary

Perianal Crohn’s disease remains highly debilitating. New regenerative medicine treatments have shown conflicting results for patients resistant to conventional therapies. Our study with the combination of microfragmented adipose tissue injection and surgical drainage of sepsis, confirms the long-term safety and efficacy of this novel therapy.

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