INTESTINAL TRANSPLANTATION IN CHILDREN – A SINGLE CENTER EXPERIENCE OVER 100 CASES

Abstract

O20 Aim: To describe single center experience of pediatric intestinal transplantation (Itx) over 10 years. Methods: Retrospective analysis of children who underwent Itx at our institution since August 1994. Results were compared in 4 different groups: Group 1(8/94-12/97, n=26), Group 2 (01/98-12/00, n=30), Group 3 (01/01-04/03, with no Campath-1H induction, n=41) and Group 4 (01/01-04/04, with Campath-1H induction, n=21). Results: 104 children received 118 Itx during overall study period. The median age was 17.5 months (range 6 months to 17 years). Major causes of intestinal failure were: short gut syndrome due to gastroschisis (n=33), NEC (n=17), pseudoobstruction/megacystis microcolon (n=12), volvulus (n=10), intestinal atresia (n=12) Hirschsprung’s disease (n=10), and microvillus inclusion disease (n=4). The types of graft included isolated intestine (n=28), composite liver and intestine (n=23), non-composite liver and intestine (n=4), multivisceral (n=56), and multivisceral without the liver (n=6). The pancreaticoduodenal complex was included in 16 composite liver and intestinal grafts and kidneys were included in 9 multivisceral grafts. Tacrolimus was used as baseline immunosuppression in all patients. Induction with OKT3, cyclophosphamide or MMF was used in Group 1. Daclizumab was used in Group 2 and Group 3. Patients in Group 4 received Campath 1H induction. Seventy-three patients (70%) had concomitant liver failure at the time of transplant. Presence of concomitant liver failure was more common in younger population (87% in age <1.5y, vs 53% in age >1.5y, p=0.0001). Fifty patients are currently alive. Two children survived more than 8 years and additional 8 survived more than 5 years. Actuarial patient survivals at 6-month/1-year/2-year were 48%/44%/32%, 61%/54%/47%, 91%/84%/74%, and 60%/47%/47% in Group 1,2,3 and 4, respectively. Incidences of severe rejection were 36%, 23%, 14% and 6% in Group 1, 2, 3 and 4, respectively. Viral infections seen in these children included CMV (n=12), adenovirus (n=7), and RSV (n=6) infections. Nine patients (9%)developed PTLD; two died of generallized PTLD, three required re-transplant and the remaining were treated successfully with the use of rituximab. Recent transplant year (p=0.004) and absent of severe rejection (p=0.014) positively influenced patient survival. Conclusions: Itx provided reasonable chance of survival in children with intestinal failure and TPN related complication. Main indication for Itx in younger age was development of liver failure. Patient survival improved significantly in recent years with decreased incidence of severe rejection. Effect of Campath-1H induction has yet to be determined in pediatric transplant recipients.