Intestinal transplantation in children: A summary of clinical outcomes and prognostic factors in 108 patients from a single center

Tomoaki Kato, Jeffrey J. Gaynor, Genarro Selvaggi, Naveen Mittal, John F. Thompson, Gwenn E. McLaughlin, Seigo Nishida, Jang Moon, David Levi, Juan Madariaga, Phillip Ruiz, Andreas Tzakis

Research output: Contribution to journalArticle

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Abstract

We performed 124 intestinal transplants on 108 children (median age, 1.5 years) since 1994. Initial graft types included isolated intestine (I) (n = 26), liver and intestine (LI) (n = 26), multivisceral (MV) (n = 50), and multivisceral without liver (MMV) (n = 6). Four groups were defined by type of induction therapy: none, OKT3, or cyclophosphamide (August 1994-December 1997, n = 25), early experience with daclizumab (January 1998-December 2000, n = 26), recent experience with daclizumab (January 2001-April 2004, n = 40), and Campath-1H (January 2001-April 2004, n = 17). Actuarial patient survival at 1 year for groups 1-4 was 44%±10%, 54%±10%, 83%±6%, and 41%±12%, respectively, with group 3 having the most favorable survival (P = 0.0004). Using Cox stepwise regression, the hazard rate of developing severe rejection was significantly higher in patients with transplant type I or LI (P = 0.0002), with no difference between these groups (P = 0.24) but a significantly higher rate for LI versus MV (P = 0.005). Three factors associated with improved patient survival were recipient of MV or MMV (P = 0.008), age at transplantation greater than 1 year (P = 0.01), and use of daclizumab (P = 0.0006). Cause-specific hazard analysis revealed a decreased rate of rejection-related mortality for recipients of MV or MMV (P = 0.0007), whereas age greater than 1 year indicated a lower rate of infection-related mortality (P = 0.0009). Pediatric intestinal transplantation provides an increasingly realistic chance of survival, particularly with the more recent use of daclizumab and multivisceral transplantation. A protective effect of multivisceral transplantation appears to exist with respect to the development of severe rejection.

Original languageEnglish (US)
Pages (from-to)75-89
Number of pages15
JournalJournal of Gastrointestinal Surgery
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Intestines
Transplantation
Survival
Liver
Transplants
Muromonab-CD3
Mortality
Cyclophosphamide
Pediatrics
daclizumab
Infection
Therapeutics

Keywords

  • children
  • clinical outcomes
  • Intestinal transplantation
  • prognostic factors
  • single-center experience

ASJC Scopus subject areas

  • Surgery

Cite this

Intestinal transplantation in children : A summary of clinical outcomes and prognostic factors in 108 patients from a single center. / Kato, Tomoaki; Gaynor, Jeffrey J.; Selvaggi, Genarro; Mittal, Naveen; Thompson, John F.; McLaughlin, Gwenn E.; Nishida, Seigo; Moon, Jang; Levi, David; Madariaga, Juan; Ruiz, Phillip; Tzakis, Andreas.

In: Journal of Gastrointestinal Surgery, Vol. 9, No. 1, 01.01.2005, p. 75-89.

Research output: Contribution to journalArticle

Kato, T, Gaynor, JJ, Selvaggi, G, Mittal, N, Thompson, JF, McLaughlin, GE, Nishida, S, Moon, J, Levi, D, Madariaga, J, Ruiz, P & Tzakis, A 2005, 'Intestinal transplantation in children: A summary of clinical outcomes and prognostic factors in 108 patients from a single center', Journal of Gastrointestinal Surgery, vol. 9, no. 1, pp. 75-89. https://doi.org/10.1016/j.gassur.2004.10.012
Kato, Tomoaki ; Gaynor, Jeffrey J. ; Selvaggi, Genarro ; Mittal, Naveen ; Thompson, John F. ; McLaughlin, Gwenn E. ; Nishida, Seigo ; Moon, Jang ; Levi, David ; Madariaga, Juan ; Ruiz, Phillip ; Tzakis, Andreas. / Intestinal transplantation in children : A summary of clinical outcomes and prognostic factors in 108 patients from a single center. In: Journal of Gastrointestinal Surgery. 2005 ; Vol. 9, No. 1. pp. 75-89.
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