Isolated Intestinal Transplant in Pediatric Patiens, Results from a Single Center.

MARIA INÉS MARTINEZ; CAROLINA RUMBO; DIEGO RAMISCH; PABLO ROMERO; GUILLERMO ORCE; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Background: Intestinal Transplant (Itx) is indicated when long termparenteral nutrition complications arise. This is a therapeutic optionthat has developed in Latinamerica in recent years.Aim: to describe a group of pediatric patients that underwent isolatedItx, their post transplant clinical course, graft and patient survival ata single Itx unit in Argentina.Material and Methods: Retrospective descriptive analysis of patients(pts) < 18 years of age, that underwent primary isolated Itx between03/2006 and 12/2014. Age at Itx, time on PN pre Itx, time onwaiting list, intestinal failure diagnosis, Itx indication, nutritional status(NS) (BMI/age and height/age), induction immunosuppression, needfor non conventional vascular accesses at Itx, post Itx complications,survival and cause of dead are analyzed. SPSS was used for statisticalanalysis.Results: Mean age at Itx was 6.4 ±4.6 years, mean pre Itx time onPN was 4.6 ±3.9 years. Mean time on waiting list was 247 ±191 days.Diagnosis: short gut in 18 (86%), 2 (9%) intractable diarrhea, 1 (4.5%)CIPO. Itx indication was lack of vascular accesses in 13 (62%), 4(19%) recurrent sepsis, 2 (9%) liver disease and in 2 (9%) othercauses. NS at Itx was: mean BMI -0.73 ±1.44 (< -2 DS in 9%) andmean height/age -2.3 ±1.8 (< -2 DS in 52%). In 19% non-conventionalvascular accesses were used at Itx. 28% received Thymoglobulin asinduction immunosuppression due to high immunological risk (highlysensitized, ABO compatible mismatch or positive B cells crossmatch),the rest received basiliximab as induction.Surgical complications occurred in 8 (38%), PTLD in 2(10%), postItx diabetes in 4 (20%). There were no GVHD or tumors in this patientpopulation.Patient actuarial survival was 80% and 63% at 1 and 5 years respectively.Graft survival was 62% and 53% at 1 and 5 years respectively.Four patients died due to infections, one due to liver disease postexplant and another due to GVHD post re transplantation.Conclusions:Lack of vascular accesses is the main indication for Itx in this series,and short gut the first cause of intestinal failure.NS showed high prevalence of chronic malnourishment in this group.Rejection and infections were the most frequent complications.Graft and patient survival are comparable to those reported by theInternational Transplant Registry.References:1. Pediatr Surg Int. 2013 Nov;29(11):1115-8. doi: 10.1007/s00383-013-3375-8.2. Clin Nutr. 2014 Apr 30. pii: S0261-5614(14)00123-X. doi:10.1016/j.clnu.2014.04.015.3. J Pediatr Surg. 2011 Feb;46(2):280-3. doi: 10.1016/j.jpedsurg.2010.11.002