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Current status of intestinal transplantation in children

Reyes, J and Bueno, J and Kocoshis, S and Green, M and Abu-Elmagd, K and Furukawa, H and Barksdale, EM and Strom, S and Fung, JJ and Todo, S and Irish, W and Starzl, TE (1998) Current status of intestinal transplantation in children. Journal of Pediatric Surgery, 33 (2). 243 - 254. ISSN 0022-3468

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Abstract

Purpose: A clinical trial of intestinal transplantation (Itx) under tacrolimus and prednisone immunosuppression was initiated in June 1990 in children with irreversible intestinal failure and who were dependent on total parenteral nutrition (TPN). Methods: Fifty-five patients (28 girls, 27 boys) with a median age of 3.2 years (range, 0.5 to 18 years) received 58 intestinal transplants that included isolated small bowel (SB) (n = 17), liver SB (LSB) (n = 33), and multivisceral (MV) (n = 8) allografts. Nine patients also received bone marrow infusion, and there were 20 colonic allografts. Azathioprine, cyclophosphamide, or mycophenolate mofetil were used in different phases of the series. Indications for Itx included: gastroschisis (n = 14), volvulus (n = 13), necrotizing enterocolitis (n = 6), intestinal atresia (n = 8), chronic intestinal pseudoobstruction (n = 5), Hirschsprung's disease (n = 4), microvillus inclusion disease (n = 3), multiple polyposis (n = 1), and trauma (n = 1). Results: Currently, 30 patients are alive (patient survival, 55%; graft survival, 52%). Twenty-nine children with functioning grafts are living at home and off TPN, with a mean follow-up of 962 (range, 75 to 2,424) days. Immunologic complications have included liver allograft rejection (n = 18), intestinal allograft rejection (n = 52), posttransplant lymphoproliferative disease (n = 16), cytomegalovirus (n = 16) and graft-versus-host disease (n = 4). A combination of associated complications included intestinal perforation (n = 4), biliary leak (n = 3), bile duct stenosis (n = 1), intestinal leak (n = 6), dehiscence with evisceration (n = 4), hepatic artery thrombosis (n = 3), bleeding (n = 9), portal vein stenosis (n = 1), intraabdominal abscess (n = 11), and chylous ascites (n = 4). Graft loss occurred as a result of rejection (n = 8), infection (n = 12), technical complications (n = 8), and complications of TPN after graft removal (n = 3). There were four retransplants (SB, n = 1; LSB n = 3). Conclusions: Intestinal transplantation is a valid therapeutic option for patients with intestinal failure suffering complications of TPN. The complex clinical and immunologic course of these patients is reflected in a higher complication rate as well as patient and graft loss than seen after heart, liver, and kidney transplantation, although better than after lung transplantation.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Reyes, J
Bueno, J
Kocoshis, S
Green, M
Abu-Elmagd, K
Furukawa, H
Barksdale, EM
Strom, S
Fung, JJ
Todo, S
Irish, W
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1998
Date Type: Publication
Journal or Publication Title: Journal of Pediatric Surgery
Volume: 33
Number: 2
Page Range: 243 - 254
DOI or Unique Handle: 10.1016/s0022-3468(98)90440-7
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0022-3468
Other ID: uls-drl:31735062127166, Starzl CV No. 1994
Date Deposited: 08 Apr 2010 17:34
Last Modified: 17 Oct 2017 01:55
URI: http://d-scholarship.pitt.edu/id/eprint/5380

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