Intestinal and multivisceral transplantation in children

Tomoaki Kato, Andreas G. Tzakis, Gennaro Selvaggi, Jeffrey Gaynor, Andre I. David, Alessandro Bussotti, Jang I. Moon, Takehisa Ueno, Werviston DeFaria, Sergio F Santiago, David M. Levi, Seigo Nishida, Monica L. Velasco, Gwenn E McLaughlin, Erick Hernandez, John F. Thompson, G. Patricia Cantwell, Norman Holliday, Alan Livingstone, Phillip Ruiz

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Abstract

OBJECTIVE: To describe a single-center experience of pediatric intestinal transplantation (Itx) and to provide an overview of the children who underwent this procedure along with their outcomes. SUMMARY BACKGROUND DATA: Pediatric Itx presents multiple challenges because of the very young ages at which patients require transplantation and their higher susceptibility to infectious complications. METHODS: We have performed 141 Itx in 123 children with a median age of 1.37 years. Primary grafts included isolated intestine (n = 28), liver and intestine (n = 27), multivisceral (n = 61), and multivisceral without the liver (n = 7). Two protocol modifications were introduced in 1998: daclizumab induction and frequent rejection surveillance. In 2001, indications for multivisceral transplantation were expanded, and induction with Campath-1H was introduced. RESULTS: Actuarial patient survival at 1 and 3 years for group 1 (January 1994 to December 1997, n = 25), group 2 (January 1998 to March 2001, n = 29), group 3a (April 2001 to present, daclizumab, n = 51), and group 3b (April 2001 to present, Campath-1H, n = 18) was 44%/32%, 52%/38%, 83%/60%, and 44%/44%, respectively (P = 0.0003 in favor of group 3a). Severe rejection implied a dismal prognosis (65% mortality at 6 months). Observed incidence of severe rejection in groups 1, 2, 3a, and 3b was 32%, 24%, 14%, and 11%, respectively. In multivariable analysis, use of a multivisceral (with or without liver) transplant (P = 0.002), induction with daclizumab (P = 0.005), patient at home prior to transplant (P = 0.007), and age at transplant ≥1 year (P = 0.02) favorably influenced patient survival. Multivisceral transplant was protective with respect to the mortality rate due to rejection, while an older age at transplant was associated with both a lower incidence rate of developing respiratory infection and lower risk of mortality following the respiratory infection. Survivors are off parenteral nutrition and have demonstrated significant growth catch-up. CONCLUSIONS: Itx in children still is a high-risk procedure but has now become a viable option for children who otherwise have no hope for survival. Control of respiratory infection is of particular importance in the younger children.

Original languageEnglish
Pages (from-to)756-764
Number of pages9
JournalAnnals of Surgery
Volume243
Issue number6
DOIs
StatePublished - Jun 1 2006

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Transplantation
Transplants
Respiratory Tract Infections
Intestines
Survival
Mortality
Liver
Pediatrics
Incidence
Parenteral Nutrition
Survivors
Growth
daclizumab
alemtuzumab

ASJC Scopus subject areas

  • Surgery

Cite this

Intestinal and multivisceral transplantation in children. / Kato, Tomoaki; Tzakis, Andreas G.; Selvaggi, Gennaro; Gaynor, Jeffrey; David, Andre I.; Bussotti, Alessandro; Moon, Jang I.; Ueno, Takehisa; DeFaria, Werviston; Santiago, Sergio F; Levi, David M.; Nishida, Seigo; Velasco, Monica L.; McLaughlin, Gwenn E; Hernandez, Erick; Thompson, John F.; Patricia Cantwell, G.; Holliday, Norman; Livingstone, Alan; Ruiz, Phillip.

In: Annals of Surgery, Vol. 243, No. 6, 01.06.2006, p. 756-764.

Research output: Contribution to journalArticle

Kato, T, Tzakis, AG, Selvaggi, G, Gaynor, J, David, AI, Bussotti, A, Moon, JI, Ueno, T, DeFaria, W, Santiago, SF, Levi, DM, Nishida, S, Velasco, ML, McLaughlin, GE, Hernandez, E, Thompson, JF, Patricia Cantwell, G, Holliday, N, Livingstone, A & Ruiz, P 2006, 'Intestinal and multivisceral transplantation in children', Annals of Surgery, vol. 243, no. 6, pp. 756-764. https://doi.org/10.1097/01.sla.0000219696.11261.13
Kato, Tomoaki ; Tzakis, Andreas G. ; Selvaggi, Gennaro ; Gaynor, Jeffrey ; David, Andre I. ; Bussotti, Alessandro ; Moon, Jang I. ; Ueno, Takehisa ; DeFaria, Werviston ; Santiago, Sergio F ; Levi, David M. ; Nishida, Seigo ; Velasco, Monica L. ; McLaughlin, Gwenn E ; Hernandez, Erick ; Thompson, John F. ; Patricia Cantwell, G. ; Holliday, Norman ; Livingstone, Alan ; Ruiz, Phillip. / Intestinal and multivisceral transplantation in children. In: Annals of Surgery. 2006 ; Vol. 243, No. 6. pp. 756-764.
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abstract = "OBJECTIVE: To describe a single-center experience of pediatric intestinal transplantation (Itx) and to provide an overview of the children who underwent this procedure along with their outcomes. SUMMARY BACKGROUND DATA: Pediatric Itx presents multiple challenges because of the very young ages at which patients require transplantation and their higher susceptibility to infectious complications. METHODS: We have performed 141 Itx in 123 children with a median age of 1.37 years. Primary grafts included isolated intestine (n = 28), liver and intestine (n = 27), multivisceral (n = 61), and multivisceral without the liver (n = 7). Two protocol modifications were introduced in 1998: daclizumab induction and frequent rejection surveillance. In 2001, indications for multivisceral transplantation were expanded, and induction with Campath-1H was introduced. RESULTS: Actuarial patient survival at 1 and 3 years for group 1 (January 1994 to December 1997, n = 25), group 2 (January 1998 to March 2001, n = 29), group 3a (April 2001 to present, daclizumab, n = 51), and group 3b (April 2001 to present, Campath-1H, n = 18) was 44{\%}/32{\%}, 52{\%}/38{\%}, 83{\%}/60{\%}, and 44{\%}/44{\%}, respectively (P = 0.0003 in favor of group 3a). Severe rejection implied a dismal prognosis (65{\%} mortality at 6 months). Observed incidence of severe rejection in groups 1, 2, 3a, and 3b was 32{\%}, 24{\%}, 14{\%}, and 11{\%}, respectively. In multivariable analysis, use of a multivisceral (with or without liver) transplant (P = 0.002), induction with daclizumab (P = 0.005), patient at home prior to transplant (P = 0.007), and age at transplant ≥1 year (P = 0.02) favorably influenced patient survival. Multivisceral transplant was protective with respect to the mortality rate due to rejection, while an older age at transplant was associated with both a lower incidence rate of developing respiratory infection and lower risk of mortality following the respiratory infection. Survivors are off parenteral nutrition and have demonstrated significant growth catch-up. CONCLUSIONS: Itx in children still is a high-risk procedure but has now become a viable option for children who otherwise have no hope for survival. Control of respiratory infection is of particular importance in the younger children.",
author = "Tomoaki Kato and Tzakis, {Andreas G.} and Gennaro Selvaggi and Jeffrey Gaynor and David, {Andre I.} and Alessandro Bussotti and Moon, {Jang I.} and Takehisa Ueno and Werviston DeFaria and Santiago, {Sergio F} and Levi, {David M.} and Seigo Nishida and Velasco, {Monica L.} and McLaughlin, {Gwenn E} and Erick Hernandez and Thompson, {John F.} and {Patricia Cantwell}, G. and Norman Holliday and Alan Livingstone and Phillip Ruiz",
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T1 - Intestinal and multivisceral transplantation in children

AU - Kato, Tomoaki

AU - Tzakis, Andreas G.

AU - Selvaggi, Gennaro

AU - Gaynor, Jeffrey

AU - David, Andre I.

AU - Bussotti, Alessandro

AU - Moon, Jang I.

AU - Ueno, Takehisa

AU - DeFaria, Werviston

AU - Santiago, Sergio F

AU - Levi, David M.

AU - Nishida, Seigo

AU - Velasco, Monica L.

AU - McLaughlin, Gwenn E

AU - Hernandez, Erick

AU - Thompson, John F.

AU - Patricia Cantwell, G.

AU - Holliday, Norman

AU - Livingstone, Alan

AU - Ruiz, Phillip

PY - 2006/6/1

Y1 - 2006/6/1

N2 - OBJECTIVE: To describe a single-center experience of pediatric intestinal transplantation (Itx) and to provide an overview of the children who underwent this procedure along with their outcomes. SUMMARY BACKGROUND DATA: Pediatric Itx presents multiple challenges because of the very young ages at which patients require transplantation and their higher susceptibility to infectious complications. METHODS: We have performed 141 Itx in 123 children with a median age of 1.37 years. Primary grafts included isolated intestine (n = 28), liver and intestine (n = 27), multivisceral (n = 61), and multivisceral without the liver (n = 7). Two protocol modifications were introduced in 1998: daclizumab induction and frequent rejection surveillance. In 2001, indications for multivisceral transplantation were expanded, and induction with Campath-1H was introduced. RESULTS: Actuarial patient survival at 1 and 3 years for group 1 (January 1994 to December 1997, n = 25), group 2 (January 1998 to March 2001, n = 29), group 3a (April 2001 to present, daclizumab, n = 51), and group 3b (April 2001 to present, Campath-1H, n = 18) was 44%/32%, 52%/38%, 83%/60%, and 44%/44%, respectively (P = 0.0003 in favor of group 3a). Severe rejection implied a dismal prognosis (65% mortality at 6 months). Observed incidence of severe rejection in groups 1, 2, 3a, and 3b was 32%, 24%, 14%, and 11%, respectively. In multivariable analysis, use of a multivisceral (with or without liver) transplant (P = 0.002), induction with daclizumab (P = 0.005), patient at home prior to transplant (P = 0.007), and age at transplant ≥1 year (P = 0.02) favorably influenced patient survival. Multivisceral transplant was protective with respect to the mortality rate due to rejection, while an older age at transplant was associated with both a lower incidence rate of developing respiratory infection and lower risk of mortality following the respiratory infection. Survivors are off parenteral nutrition and have demonstrated significant growth catch-up. CONCLUSIONS: Itx in children still is a high-risk procedure but has now become a viable option for children who otherwise have no hope for survival. Control of respiratory infection is of particular importance in the younger children.

AB - OBJECTIVE: To describe a single-center experience of pediatric intestinal transplantation (Itx) and to provide an overview of the children who underwent this procedure along with their outcomes. SUMMARY BACKGROUND DATA: Pediatric Itx presents multiple challenges because of the very young ages at which patients require transplantation and their higher susceptibility to infectious complications. METHODS: We have performed 141 Itx in 123 children with a median age of 1.37 years. Primary grafts included isolated intestine (n = 28), liver and intestine (n = 27), multivisceral (n = 61), and multivisceral without the liver (n = 7). Two protocol modifications were introduced in 1998: daclizumab induction and frequent rejection surveillance. In 2001, indications for multivisceral transplantation were expanded, and induction with Campath-1H was introduced. RESULTS: Actuarial patient survival at 1 and 3 years for group 1 (January 1994 to December 1997, n = 25), group 2 (January 1998 to March 2001, n = 29), group 3a (April 2001 to present, daclizumab, n = 51), and group 3b (April 2001 to present, Campath-1H, n = 18) was 44%/32%, 52%/38%, 83%/60%, and 44%/44%, respectively (P = 0.0003 in favor of group 3a). Severe rejection implied a dismal prognosis (65% mortality at 6 months). Observed incidence of severe rejection in groups 1, 2, 3a, and 3b was 32%, 24%, 14%, and 11%, respectively. In multivariable analysis, use of a multivisceral (with or without liver) transplant (P = 0.002), induction with daclizumab (P = 0.005), patient at home prior to transplant (P = 0.007), and age at transplant ≥1 year (P = 0.02) favorably influenced patient survival. Multivisceral transplant was protective with respect to the mortality rate due to rejection, while an older age at transplant was associated with both a lower incidence rate of developing respiratory infection and lower risk of mortality following the respiratory infection. Survivors are off parenteral nutrition and have demonstrated significant growth catch-up. CONCLUSIONS: Itx in children still is a high-risk procedure but has now become a viable option for children who otherwise have no hope for survival. Control of respiratory infection is of particular importance in the younger children.

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