Expanded Use of Multivisceral Transplantation for Small Children With Concurrent Liver and Intestinal Failure

T. Kato, Gennaro Selvaggi, Jeffrey Gaynor, J. Madariaga, Gwenn E McLaughlin, J. Thompson, Seigo Nishida, J. Moon, D. Levi, Phillip Ruiz, A. Tzakis

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Fifty-five children with liver and intestinal failure have been transplanted at our center under daclizumab induction therapy since 1998. Of those, 19 received five multiviceral transplantation (MVT), 12 liver-intestine-pancreas transplants, and 2 noncomposite liver and intestine transplants (NCLIT) before 2001 (group 1). During this period, MVT was only used in children with gastric dysmotility. After 2001, we expanded the use of MVT. Therefore, 36 children in this period (group 2) received MVT except for two who received NCLIT. Median age was 1.08 in group 1 and 1.06 in group 2. Median recipient weight was 8.2 kg in group 1 and 7.5 kg in group 2. Six-month, 1-, and 2-year patient survivals were 54%, 37%, and 32% in group 1 and 94%, 91%, and 71% in group 2 (P = .00037). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019) Four died of rejection in group 1 (21%); none died of rejection in group 2. There have been two esophago-gastrostomy strictures (one in each group) and a serious reflux of this anastomosis (group 2). Strictures were treated with balloon dilatation, and the reflux was surgically corrected. In 24 recent cases, gastro-gastric anastomosis was used in MVT with no complications to date. No pancreatic rejection was seen. Small children tolerated MVT with improved survival rates and reduced rates of rejection. Use of MVT may be considered as an alternative to liver-intestine-pancreas transplant.

Original languageEnglish
Pages (from-to)1705-1708
Number of pages4
JournalTransplantation Proceedings
Volume38
Issue number6
DOIs
StatePublished - Jul 1 2006

Fingerprint

Liver Failure
Transplantation
Intestines
Transplants
Pancreas
Liver
Stomach
Pathologic Constriction
Gastrostomy
Liver Transplantation
Dilatation
Survival Rate
Weights and Measures
Survival

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Expanded Use of Multivisceral Transplantation for Small Children With Concurrent Liver and Intestinal Failure. / Kato, T.; Selvaggi, Gennaro; Gaynor, Jeffrey; Madariaga, J.; McLaughlin, Gwenn E; Thompson, J.; Nishida, Seigo; Moon, J.; Levi, D.; Ruiz, Phillip; Tzakis, A.

In: Transplantation Proceedings, Vol. 38, No. 6, 01.07.2006, p. 1705-1708.

Research output: Contribution to journalArticle

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abstract = "Fifty-five children with liver and intestinal failure have been transplanted at our center under daclizumab induction therapy since 1998. Of those, 19 received five multiviceral transplantation (MVT), 12 liver-intestine-pancreas transplants, and 2 noncomposite liver and intestine transplants (NCLIT) before 2001 (group 1). During this period, MVT was only used in children with gastric dysmotility. After 2001, we expanded the use of MVT. Therefore, 36 children in this period (group 2) received MVT except for two who received NCLIT. Median age was 1.08 in group 1 and 1.06 in group 2. Median recipient weight was 8.2 kg in group 1 and 7.5 kg in group 2. Six-month, 1-, and 2-year patient survivals were 54{\%}, 37{\%}, and 32{\%} in group 1 and 94{\%}, 91{\%}, and 71{\%} in group 2 (P = .00037). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019) Four died of rejection in group 1 (21{\%}); none died of rejection in group 2. There have been two esophago-gastrostomy strictures (one in each group) and a serious reflux of this anastomosis (group 2). Strictures were treated with balloon dilatation, and the reflux was surgically corrected. In 24 recent cases, gastro-gastric anastomosis was used in MVT with no complications to date. No pancreatic rejection was seen. Small children tolerated MVT with improved survival rates and reduced rates of rejection. Use of MVT may be considered as an alternative to liver-intestine-pancreas transplant.",
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