EXPANDING INDICATIONS FOR INTESTINAL TRANSPLANTATION

Abstract

756 Aim: Compare current indications for intestinal and multivisceral transplantation among pediatric and adult recipients. Methods: Recipients of consecutive intestinal and multivisceral transplantation from 1-90 to 12-98 were classified according to indication and operation performed. Results: 70 children at a mean age of 5.2 years (range=.5-18.3) and 48 adults at a mean age of 36.2 years (range =19.1-58.6) underwent 125 transplants consisting of 46 isolated intestine (ITX), 59 liver-small bowel (L-ITX) and 20 multivisceral grafts (MVX). All patients presented with irreversible chronic intestinal failure, TPN dependency, and complications arising from their TPN use. Combined L-ITX or MVX were performed for combined organ failure or to correct the underlying disorder leading to short gut such as hypercoagulability states complicated by mesenteric thrombosis. The following table shows the indications for intestinal transplant. (Table)TableConclusion: The most common indication for transplant is short gut syndrome from a variety of causes. In children, the majority of patients are transplanted for volvulus (27%), gastroschisis (21%), and NEC and intestinal atresia, 12% and 11%, respectively. In adults, the most common cause of short gut is mesenteric thrombosis (26%), trauma (14%) and Crohn's Disease (20%). Defective motility (pseudo-obstruction or Hirschsprung Disease) is more common in children (15%) than adults (2%). Transplant for impaired absorption (microvillus inclusion disease or radiation enteritis) is uncommon in both adults (8%) and children (12%).