O-42: Pediatric Composite Liver-intestine Transplantation with Native Splenopancreatic Preservation: Immunologic Complications and Long-term Outcomes

Abstract

Introduction: Combined liver-intestine transplantation is the only proven treatment for the moribund child with intestinal failure and decompensated liver disease. Native splenopancreatic preservation may provide immunologic benefits that results in improved long-term outcomes. Methods: All pediatric patients who underwent combined liver-intestine transplantation with native splenopancreatic preservation at our institution from November 2003 until June 2019 were included in this study. Freedom from rejection and survival were estimated using the Kaplan-Meier method. Risk factors for graft loss and death were identified using Cox proportional hazard regression analysis. Results: Pediatric recipients included 68 infants with a median follow up of 9.8 years. Recipient median age was 1.3 years old with a median weight of 9.3kg and were more commonly male. Short gut syndrome was the most etiology of intestinal failure. Donors were generally younger (median age 0.4 years old) and smaller (median weight 6.9kg) than recipients. The most common cause of donor death was intracranial hemorrhage. Early rejection (<1 year) occurred in 10 (15%) and late rejection (>1 year) in 9 (13%) recipients. De novo donor specific antibody developed in 17 (25%) recipients. PTLD occurred in 4 (5.9%) and GVHD in 4 (5.9%) recipients. The 10-year survival with a functioning graft was 80.4% in this group. Multivariate Cox regression analysis identified inpatient status at time of transplant, donor-recipient weight ratio >0.9, and development of GVHD as statistically significant risk factors for graft loss and death after transplant. Conclusions: In this large pediatric cohort of combined liver-intestine transplant recipients with native splenopancreatic preservation there was a relatively low rate of immunologic complications and excellent long-term outcomes.