P3A.05: Young donors (age ≤ 6 months) for Intestinal transplantation (ITX): are they high risk?

Abstract

Introduction: ITX is accepted treatment for children with irreversible intestinal failure. Shortage of size matched organs for children especially those with restricted abdominal domain due to various aetiologies resulted in development of various techniques including use of organs from young donors. There is no data on the utilization and outcome of young donors in ITX. Subject and Methods: Retrospective review of medical records between 1993–2018 of all ITX from donors less than 6 months of age. Donor and recipients demographics, intra and early post-transplant complications, short and long term graft and patient outcome were analysed. Results: 4 females median age 20 months & weight 9kg underwent ITX from young female DBD donors median age 3.5 months & weight 6kg with median donor to recipient weight ratio 0.5 (Table 1). All donors with brain death, blood group identical/compatible with median cold ischemia time 5.5 hours. No surgical complications noted intra or early post-transplant. Two died early within 3 months of ITx following severe acute rejection. One established early full enteral feeding and required laparotomy for stoma prolapse 3 months post ITX, but eventually died secondary to complications. The second child took longtime to establish feeding due to fluid and electrolyte imbalance, but eventually died following complications associated with stoma closure. One year patient and graft survival was 50%, whilst 3 year patient and graft survival was 0%. Conclusion: It is technically feasible to consider young donors for intestinal transplantation. In our experience it is associated with a high mortality. Further investigation to understand the complex interactions between the naive immune system of the young donors with the mature immune system of the older recipients may hold the key to understanding the development of the immunological complications.