ABSTRACTS: Oral Presentation Abstracts
Introduction: To describe single center experience of pediatric intestinal transplantation (Itx) over 10 years.
Methods: Retrospective analysis of children who underwent Itx at our institution since August 1994. Results were compared in 4 different groups: Group 1(8/94–12/97, n=26), Group 2 (01/98–12/00, n=30), Group 3 (01/01–12/03, with no Campath-1H induction, n=38) and Group 4 (01/01–12/03, with Campath-1H induction, n=21).
Results: 102 children received 115 Itx during overall study period. The median age was 17.5 months (range 6 months to 17 years). Intestinal failure was due to short gut syndrome (87), motility disorder (11) and microvillus inclusion disease (n=4). The types of graft included isolated intestine (n=28), composite liver and intestine (n=23), non-composite liver and intestine (n=4), multivisceral (n=54), and multivisceral without the liver (n=6). Tacrolimus was used as baseline immunosuppression in all patients. Induction with OKT3, cyclophosphamide or MMF was used in Group 1. Daclizumab was used in Group 2 and Group 3. Patients in Group 4 received Campath 1H induction. Seventy-two patients (71%) had concomitant liver failure at the time of transplant. Presence of concomitant liver failure was more common in younger population (87% in age <1.5y, vs 53% in age >1.5y, p=0.0001). Fifty patients are currently alive on full enteral nutrition. Two children survived more than 8 years and additional 8 survived more than 5 years. Actuarial patient survivals at 6-month/1-year/2-year were 48%/44%/32%, 61%/54%/47%, 91%/84%/74%, and 60%/47%/47% in Group 1,2,3 and 4, respectively. Incidences of severe rejection were 36%, 23%, 11% and 0% in Group 1, 2, 3 and 4, respectively. Viral infections seen in these children included CMV (n=12), adenovirus (n=7), and RSV (n=6) infections. Nine patients (9%)developed PTLD; two died of generallized PTLD, three required re-transplant and the remaining were treated successfully with the use of rituximab. Patients less than 24 mos in Group 4 experienced higher rate of pulmonary complications, including ARDS in 3.
Recent transplant year (p=0.004) and absence of severe rejection (p=0.014) positively influenced patient survival.
Conclusion: Conclusions Itx provided reasonable chance of survival in children with intestinal failure and TPN related complication. Main indication for Itx in younger age was development of liver failure. Patient survival improved significantly in recent years with decreased incidence of severe rejection. Effect of Campath-1H induction has yet to be determined in pediatric transplant recipients.