Up-to-date evolution of small bowel transplantation in children with intestinal failure

Dominique M. Jan, Jean Luc Michel, Olivier Goulet, Sabine Sarnacki, Florence Lacaille, Diane Damotte, Jean Pierre Cezard, Yves Aigrain, Nicole Brousse, Michel Peuchmaur, Annick Rengeval, Virginie Colomb, Philippe Jouvet, Claude Ricour, Yann Révillon

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Purpose: The aim of the authors was to report an up-to-date review of their experience with 26 intestinal transplantations in children since 1987. Methods: A retrospective study was conducted of 26 patients with a mean age of 5 years (range, 0.3 to 14 years). Three groups were isolated. In group A (1987 to 1990), seven patients received nine isolated intestinal transplants for short bowel syndrome. Immunosuppression therapy consisted of cyclosporine, aziathioprine, and corticosteroids. In group B (1994-current), nine patients received nine isolated intestinal transplants for short bowel syndrom (n = 2), intestinal pseudoobstruction (n = 2), neonatal intractable diarrhea (n = 3), and Hirschsprung' disease (n = 1); hepatic biopsy results showed weak cholestasis or fibrosis. In group C (1994-current), 10 patients received 10 combined liver-small bowel transplants for short bowel syndrome (n = 3), neonatal intractable diarrhea (n = 4), and Hirschsprung' disease (n = 3); hepatic cirrhosis related to total parenteral nutrition (TPN) was shown in all cases. Groups B and C received immunosupressive treatment consisting of tacrolimus, aziathioprine, and corticosteroids. Posttransplant follow-up included intestinal biopsies of the small bowel twice a week and more frequently or combined with liver biopsy if rejection was suspected. Results: Overall patient survival (PS) and graft survival (GS) are 61% (16 of 26) and 50% (13 of 26), respectively. In group A, severe intestinal allograft rejection occurred in six patients leading to graft removal (GS, 11%). Five patients died of TPN complications after graft removal (PS, 28%). One survivor is off TPN, and one currently is waiting for a second graft. In group B, six patients survived (PS, 66%). Causes of death include hepatic failure (n = 1), renal and liver failure (n = 1), and systemic infection (n = 1). Severe intestinal allograft rejection occurred in five patients, which necessitated aggressive immunosuppression (antilymphocyte serum) leading to an incomplete functional recovery of the graft. Only two patients currently are off TPN. In group C, eight patients survived (PS, 80%) all of which are currently off TPN. One patient died during the procedure, and one died of severe systemic infection. Intestinal graft rejection occurred in six patients; rejection of the liver allograft occurred in five patients, yet all rejections were weak and successfully treated by corticosteroids (GS, 80%). Conclusions: Intestinal trans plantation is a valid therapeutic option for children with definitive intestinal failure and not only for short bowel syndrome. Tacrolimus improves graft and patient survival (group A v group B). The lower severity of graft rejection in combined liver-small bowel trans plantation improves functional results of intestinal transplantation in children without additional mortality or morbidity (group B v group C).

Original languageEnglish (US)
Pages (from-to)841-844
Number of pages4
JournalJournal of Pediatric Surgery
Volume34
Issue number5
DOIs
StatePublished - May 1999
Externally publishedYes

Fingerprint

Transplantation
Total Parenteral Nutrition
Transplants
Graft Survival
Short Bowel Syndrome
Liver
Allografts
Adrenal Cortex Hormones
Survival
Liver Failure
Graft Rejection
Tacrolimus
Biopsy
Immunosuppression
Diarrhea
Intestinal Pseudo-Obstruction
Antilymphocyte Serum
Cholestasis
Infection
Liver Cirrhosis

Keywords

  • Intestinal failure
  • Intestinal transplantation
  • Liver transplantation
  • Short gut

ASJC Scopus subject areas

  • Surgery

Cite this

Jan, D. M., Michel, J. L., Goulet, O., Sarnacki, S., Lacaille, F., Damotte, D., ... Révillon, Y. (1999). Up-to-date evolution of small bowel transplantation in children with intestinal failure. Journal of Pediatric Surgery, 34(5), 841-844. https://doi.org/10.1016/S0022-3468(99)90384-6

Up-to-date evolution of small bowel transplantation in children with intestinal failure. / Jan, Dominique M.; Michel, Jean Luc; Goulet, Olivier; Sarnacki, Sabine; Lacaille, Florence; Damotte, Diane; Cezard, Jean Pierre; Aigrain, Yves; Brousse, Nicole; Peuchmaur, Michel; Rengeval, Annick; Colomb, Virginie; Jouvet, Philippe; Ricour, Claude; Révillon, Yann.

In: Journal of Pediatric Surgery, Vol. 34, No. 5, 05.1999, p. 841-844.

Research output: Contribution to journalArticle

Jan, DM, Michel, JL, Goulet, O, Sarnacki, S, Lacaille, F, Damotte, D, Cezard, JP, Aigrain, Y, Brousse, N, Peuchmaur, M, Rengeval, A, Colomb, V, Jouvet, P, Ricour, C & Révillon, Y 1999, 'Up-to-date evolution of small bowel transplantation in children with intestinal failure', Journal of Pediatric Surgery, vol. 34, no. 5, pp. 841-844. https://doi.org/10.1016/S0022-3468(99)90384-6
Jan, Dominique M. ; Michel, Jean Luc ; Goulet, Olivier ; Sarnacki, Sabine ; Lacaille, Florence ; Damotte, Diane ; Cezard, Jean Pierre ; Aigrain, Yves ; Brousse, Nicole ; Peuchmaur, Michel ; Rengeval, Annick ; Colomb, Virginie ; Jouvet, Philippe ; Ricour, Claude ; Révillon, Yann. / Up-to-date evolution of small bowel transplantation in children with intestinal failure. In: Journal of Pediatric Surgery. 1999 ; Vol. 34, No. 5. pp. 841-844.
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abstract = "Purpose: The aim of the authors was to report an up-to-date review of their experience with 26 intestinal transplantations in children since 1987. Methods: A retrospective study was conducted of 26 patients with a mean age of 5 years (range, 0.3 to 14 years). Three groups were isolated. In group A (1987 to 1990), seven patients received nine isolated intestinal transplants for short bowel syndrome. Immunosuppression therapy consisted of cyclosporine, aziathioprine, and corticosteroids. In group B (1994-current), nine patients received nine isolated intestinal transplants for short bowel syndrom (n = 2), intestinal pseudoobstruction (n = 2), neonatal intractable diarrhea (n = 3), and Hirschsprung' disease (n = 1); hepatic biopsy results showed weak cholestasis or fibrosis. In group C (1994-current), 10 patients received 10 combined liver-small bowel transplants for short bowel syndrome (n = 3), neonatal intractable diarrhea (n = 4), and Hirschsprung' disease (n = 3); hepatic cirrhosis related to total parenteral nutrition (TPN) was shown in all cases. Groups B and C received immunosupressive treatment consisting of tacrolimus, aziathioprine, and corticosteroids. Posttransplant follow-up included intestinal biopsies of the small bowel twice a week and more frequently or combined with liver biopsy if rejection was suspected. Results: Overall patient survival (PS) and graft survival (GS) are 61{\%} (16 of 26) and 50{\%} (13 of 26), respectively. In group A, severe intestinal allograft rejection occurred in six patients leading to graft removal (GS, 11{\%}). Five patients died of TPN complications after graft removal (PS, 28{\%}). One survivor is off TPN, and one currently is waiting for a second graft. In group B, six patients survived (PS, 66{\%}). Causes of death include hepatic failure (n = 1), renal and liver failure (n = 1), and systemic infection (n = 1). Severe intestinal allograft rejection occurred in five patients, which necessitated aggressive immunosuppression (antilymphocyte serum) leading to an incomplete functional recovery of the graft. Only two patients currently are off TPN. In group C, eight patients survived (PS, 80{\%}) all of which are currently off TPN. One patient died during the procedure, and one died of severe systemic infection. Intestinal graft rejection occurred in six patients; rejection of the liver allograft occurred in five patients, yet all rejections were weak and successfully treated by corticosteroids (GS, 80{\%}). Conclusions: Intestinal trans plantation is a valid therapeutic option for children with definitive intestinal failure and not only for short bowel syndrome. Tacrolimus improves graft and patient survival (group A v group B). The lower severity of graft rejection in combined liver-small bowel trans plantation improves functional results of intestinal transplantation in children without additional mortality or morbidity (group B v group C).",
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TY - JOUR

T1 - Up-to-date evolution of small bowel transplantation in children with intestinal failure

AU - Jan, Dominique M.

AU - Michel, Jean Luc

AU - Goulet, Olivier

AU - Sarnacki, Sabine

AU - Lacaille, Florence

AU - Damotte, Diane

AU - Cezard, Jean Pierre

AU - Aigrain, Yves

AU - Brousse, Nicole

AU - Peuchmaur, Michel

AU - Rengeval, Annick

AU - Colomb, Virginie

AU - Jouvet, Philippe

AU - Ricour, Claude

AU - Révillon, Yann

PY - 1999/5

Y1 - 1999/5

N2 - Purpose: The aim of the authors was to report an up-to-date review of their experience with 26 intestinal transplantations in children since 1987. Methods: A retrospective study was conducted of 26 patients with a mean age of 5 years (range, 0.3 to 14 years). Three groups were isolated. In group A (1987 to 1990), seven patients received nine isolated intestinal transplants for short bowel syndrome. Immunosuppression therapy consisted of cyclosporine, aziathioprine, and corticosteroids. In group B (1994-current), nine patients received nine isolated intestinal transplants for short bowel syndrom (n = 2), intestinal pseudoobstruction (n = 2), neonatal intractable diarrhea (n = 3), and Hirschsprung' disease (n = 1); hepatic biopsy results showed weak cholestasis or fibrosis. In group C (1994-current), 10 patients received 10 combined liver-small bowel transplants for short bowel syndrome (n = 3), neonatal intractable diarrhea (n = 4), and Hirschsprung' disease (n = 3); hepatic cirrhosis related to total parenteral nutrition (TPN) was shown in all cases. Groups B and C received immunosupressive treatment consisting of tacrolimus, aziathioprine, and corticosteroids. Posttransplant follow-up included intestinal biopsies of the small bowel twice a week and more frequently or combined with liver biopsy if rejection was suspected. Results: Overall patient survival (PS) and graft survival (GS) are 61% (16 of 26) and 50% (13 of 26), respectively. In group A, severe intestinal allograft rejection occurred in six patients leading to graft removal (GS, 11%). Five patients died of TPN complications after graft removal (PS, 28%). One survivor is off TPN, and one currently is waiting for a second graft. In group B, six patients survived (PS, 66%). Causes of death include hepatic failure (n = 1), renal and liver failure (n = 1), and systemic infection (n = 1). Severe intestinal allograft rejection occurred in five patients, which necessitated aggressive immunosuppression (antilymphocyte serum) leading to an incomplete functional recovery of the graft. Only two patients currently are off TPN. In group C, eight patients survived (PS, 80%) all of which are currently off TPN. One patient died during the procedure, and one died of severe systemic infection. Intestinal graft rejection occurred in six patients; rejection of the liver allograft occurred in five patients, yet all rejections were weak and successfully treated by corticosteroids (GS, 80%). Conclusions: Intestinal trans plantation is a valid therapeutic option for children with definitive intestinal failure and not only for short bowel syndrome. Tacrolimus improves graft and patient survival (group A v group B). The lower severity of graft rejection in combined liver-small bowel trans plantation improves functional results of intestinal transplantation in children without additional mortality or morbidity (group B v group C).

AB - Purpose: The aim of the authors was to report an up-to-date review of their experience with 26 intestinal transplantations in children since 1987. Methods: A retrospective study was conducted of 26 patients with a mean age of 5 years (range, 0.3 to 14 years). Three groups were isolated. In group A (1987 to 1990), seven patients received nine isolated intestinal transplants for short bowel syndrome. Immunosuppression therapy consisted of cyclosporine, aziathioprine, and corticosteroids. In group B (1994-current), nine patients received nine isolated intestinal transplants for short bowel syndrom (n = 2), intestinal pseudoobstruction (n = 2), neonatal intractable diarrhea (n = 3), and Hirschsprung' disease (n = 1); hepatic biopsy results showed weak cholestasis or fibrosis. In group C (1994-current), 10 patients received 10 combined liver-small bowel transplants for short bowel syndrome (n = 3), neonatal intractable diarrhea (n = 4), and Hirschsprung' disease (n = 3); hepatic cirrhosis related to total parenteral nutrition (TPN) was shown in all cases. Groups B and C received immunosupressive treatment consisting of tacrolimus, aziathioprine, and corticosteroids. Posttransplant follow-up included intestinal biopsies of the small bowel twice a week and more frequently or combined with liver biopsy if rejection was suspected. Results: Overall patient survival (PS) and graft survival (GS) are 61% (16 of 26) and 50% (13 of 26), respectively. In group A, severe intestinal allograft rejection occurred in six patients leading to graft removal (GS, 11%). Five patients died of TPN complications after graft removal (PS, 28%). One survivor is off TPN, and one currently is waiting for a second graft. In group B, six patients survived (PS, 66%). Causes of death include hepatic failure (n = 1), renal and liver failure (n = 1), and systemic infection (n = 1). Severe intestinal allograft rejection occurred in five patients, which necessitated aggressive immunosuppression (antilymphocyte serum) leading to an incomplete functional recovery of the graft. Only two patients currently are off TPN. In group C, eight patients survived (PS, 80%) all of which are currently off TPN. One patient died during the procedure, and one died of severe systemic infection. Intestinal graft rejection occurred in six patients; rejection of the liver allograft occurred in five patients, yet all rejections were weak and successfully treated by corticosteroids (GS, 80%). Conclusions: Intestinal trans plantation is a valid therapeutic option for children with definitive intestinal failure and not only for short bowel syndrome. Tacrolimus improves graft and patient survival (group A v group B). The lower severity of graft rejection in combined liver-small bowel trans plantation improves functional results of intestinal transplantation in children without additional mortality or morbidity (group B v group C).

KW - Intestinal failure

KW - Intestinal transplantation

KW - Liver transplantation

KW - Short gut

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