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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102 Scopus citations

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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ASJC Scopus subject areas

  • Surgery

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Kato, T., Tzakis, A. G., Selvaggi, G., Gaynor, J., David, A. I., Bussotti, A., Moon, J. I., Ueno, T., DeFaria, W., Santiago, S. F., Levi, D. M., Nishida, S., Velasco, M. L., McLaughlin, G. E., Hernandez, E., Thompson, J. F., Patricia Cantwell, G., Holliday, N., Livingstone, A., & Ruiz, P. (2006). Intestinal and multivisceral transplantation in children. Annals of Surgery, 243(6), 756-764. https://doi.org/10.1097/01.sla.0000219696.11261.13