Factors Influencing Outcome After Intestinal Transplantation in Children

F. Sauvat, L. Dupic, D. Caldari, F. Lesage, J. P. Cezard, F. Lacaille, F. Ruemmele, J. P. Hugot, V. Colomb, D. Jan, P. Hubert, Y. Revillon, O. Goulet

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Abstract

We evaluated 131 patients (6 months-14 years) who experienced 21 deaths before listing, 11 continuing on the waiting list, 38 well on home parenteral nutrition, 6 off parenteral nutrition and 59 transplanted (20 girls) aged 2.5 to 15 years, (18 >7 years). They received cadaveric isolated intestine (ITx, n = 31) or liver-small bowel (LITx, n = 32), including right colon (n = 43; 23 LITx) for short bowel (n = 19), enteropathy (n = 20), Hirschsprung (n = 14), or pseudo-obstruction (n = 6). Treatment included tacrolimus, steroids, azathioprine, or interleukin-2 blockers. After 6 months to 10.5 years, the patient and graft survivals were 75% and 54%. Sixteen patients (10 LITx) died within 3 months from surgery (n = 3), bacterial (n = 5) or fungal (n = 6) sepsis, or posttransplant lymphoproliferative disorder (n = 2). Rejection occurred in 27 patients, including 10 steroid-resistant episodes requiring antilymphoglobulins. The grafts were removed due to uncontrolled rejection in seven ITx recipients. Surgical complications were observed in 38 recipients (25 LSBTx) within 2 months, including bacterial (n = 22) or fungal (n = 11) sepsis, cytomegalovirus disease (n = 12), adenovirus (n = 11), or posttransplant lymphoproliferative disorder (n = 12). Forty-two children (19 LSBTx) are alive. Weaning from parenteral nutrition was achieved after 42 days (median). Factors related to death or graft loss were pre-Tx surgery (P < .01), pseudo-obstruction (P < .01), age over 7 years (P < .03), fungal sepsis (P < .03), steroid resistant rejection (P < .05), hospitalized versus home patient (P < .01), and retransplantation (P < .05). Colon transplant did not affect the outcome. Interleukin-2 blockers improved isolated ITx (P < .05). Early referral and close monitoring of intestinal failure and related disorders are mandatory to achieve successful ITx.

Original languageEnglish (US)
Pages (from-to)1689-1691
Number of pages3
JournalTransplantation proceedings
Volume38
Issue number6
DOIs
Publication statusPublished - Jul 1 2006

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ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Sauvat, F., Dupic, L., Caldari, D., Lesage, F., Cezard, J. P., Lacaille, F., ... Goulet, O. (2006). Factors Influencing Outcome After Intestinal Transplantation in Children. Transplantation proceedings, 38(6), 1689-1691. https://doi.org/10.1016/j.transproceed.2006.05.033