Current status of intestinal transplantation in children.
Abstract | PURPOSE: METHODS: Fifty-five patients (28 girls, 27 boys) with a median age of 3.2 years (range, 0.5 to 18 years) received 58 intestinal transplants that included isolated small bowel (SB) (n = 17), liver SB (LSB) (n=33), and multivisceral (MV) (n=8) allografts. Nine patients also received bone marrow infusion, and there were 20 colonic allografts. Azathioprine, cyclophosphamide, or mycophenolate mofetil were used in different phases of the series. Indications for Itx included: gastroschisis (n=14), volvulus (n=13), necrotizing enterocolitis (n=6), intestinal atresia (n=8), chronic intestinal pseudoobstruction (n=5), Hirschsprung's disease (n=4), microvillus inclusion disease (n=3), multiple polyposis (n=1), and trauma [n=1). RESULTS: Currently, 30 patients are alive (patient survival, 55%; graft survival, 52%). Twenty-nine children with functioning grafts are living at home and off TPN, with a mean follow-up of 962 (range, 75 to 2,424) days. Immunologic complications have included liver allograft rejection (n=18), intestinal allograft rejection (n=52), posttransplant lymphoproliferative disease (n=16), cytomegalovirus (n=16) and graft-versus-host disease (n=4). A combination of associated complications included intestinal perforation (n=4), biliary leak (n=3), bile duct stenosis (n=1), intestinal leak (n=6), dehiscence with evisceration (n=4), hepatic artery thrombosis (n=3), bleeding (n=9), portal vein stenosis (n=1), intraabdominal abscess (n=11), and chylous ascites (n=4). Graft loss occurred as a result of rejection (n=8), infection (n=12), technical complications (n=8), and complications of TPN after graft removal (n=3). There were four retransplants (SB, n=1; LSB n=3). CONCLUSIONS:
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Authors | J Reyes, J Bueno, S Kocoshis, M Green, K Abu-Elmagd, H Furukawa, E M Barksdale, S Strom, J J Fung, S Todo, W Irish, T E Starzl |
Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 33
Issue 2
Pg. 243-54
(Feb 1998)
ISSN: 0022-3468 [Print] United States |
PMID | 9498395
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Child, Preschool
- Female
- Follow-Up Studies
- Graft Rejection
(epidemiology)
- Graft Survival
- Humans
- Immunosuppression Therapy
- Immunosuppressive Agents
(therapeutic use)
- Intestinal Diseases
(etiology, mortality, surgery)
- Intestines
(transplantation)
- Liver Transplantation
- Male
- Parenteral Nutrition, Total
(adverse effects)
- Postoperative Complications
(epidemiology)
- Survival Rate
- Time Factors
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