Multivisceral transplantation for pediatric intestinal pseudo-obstruction: Single center's experience of 16 cases

C. Loinaz, N. Mittal, T. Kato, B. Miller, Maria Rodriguez, A. Tzakis

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Chronic intestinal pseudo-obstruction (CIPO) in children may be life-threatening due to the complications of parenteral nutrition (PN) or catheter-related sepsis. Multivisceral transplantation (MVTx) is a lifesaving option but limited experience is available. We report our experience with MVTx in pediatric CIPO patients. Sixteen children with CIPO underwent MVTx at median age of 4 years. Indications for MVTx were liver failure (n = 10), loss of venous access (n = 3), or sepsis (n = 3). Modified MVTx without the liver was performed in six patients. Induction immunosuppression included tacrolimus, steroid with adjunctive agent in period I (April 1996 to December 2000), namely, OKT3 (n = 1), mycophenolate mofetil (n = 4), or daclizumab (n = 2); and in period II (January 2001 to present), Campath 1H (n = 4) or daclizumab (n = 5). The grade of rejection was severe in 12.5% and mild to moderate in 87.5% of cases. Isolated rejection of the transplanted stomach or pancreas was not diagnosed during clinical course or on autopsy. Actuarial patient survival for 1 year/2 years for period, I and II were 57.1%/42.9% and 88.9%/77.8%. None of the long-term survivors is on PN and all tolerate enteral feedings. Pancreatic enzyme supplementation or insulin therapy is not needed in survivors. Gastric emptying was substantially affected in one case. Bladder function did not improve in those with urinary retention problems. MVTx for CIPO offers a lifesaving option with excellent function of the transplanted pancreas and stomach among survivors.

Original languageEnglish
Pages (from-to)312-313
Number of pages2
JournalTransplantation Proceedings
Volume36
Issue number2
DOIs
StatePublished - Mar 1 2004

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Intestinal Pseudo-Obstruction
Transplantation
Pediatrics
Survivors
Parenteral Nutrition
Pancreas
Sepsis
Stomach
Mycophenolic Acid
Muromonab-CD3
Urinary Retention
Gastric Emptying
Liver Failure
Enteral Nutrition
Tacrolimus
Immunosuppression
Autopsy
Urinary Bladder
Catheters
Steroids

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Multivisceral transplantation for pediatric intestinal pseudo-obstruction : Single center's experience of 16 cases. / Loinaz, C.; Mittal, N.; Kato, T.; Miller, B.; Rodriguez, Maria; Tzakis, A.

In: Transplantation Proceedings, Vol. 36, No. 2, 01.03.2004, p. 312-313.

Research output: Contribution to journalArticle

Loinaz, C. ; Mittal, N. ; Kato, T. ; Miller, B. ; Rodriguez, Maria ; Tzakis, A. / Multivisceral transplantation for pediatric intestinal pseudo-obstruction : Single center's experience of 16 cases. In: Transplantation Proceedings. 2004 ; Vol. 36, No. 2. pp. 312-313.
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