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Early referral is essential for successful pediatric small bowel transplantation: The Canadian experience
A Fecteau1, P Atkinson, D Grant
1Department of Pediatric Surgery, The Hospital for Sick Children of Toronto, and the Pediatric Transplant Program, Children's Hospital of Western Ontario, London, Ontario, Canada.
Insights
Canadian pediatric small bowel transplant recipients face a high mortality rate while awaiting organs. Late referrals and donor shortages significantly impact transplant success rates for children.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Organ replacement therapy
Background:
- High mortality rates in pediatric patients awaiting small bowel transplantation impact overall program effectiveness.
- Understanding outcomes in the tacrolimus era is crucial for improving pediatric small bowel transplantation.
Purpose of the Study:
- To determine the outcomes of Canadian children assessed for small bowel transplantation.
- To evaluate the fate of pediatric patients on the small bowel transplant waiting list.
- To assess the outcomes of pediatric small bowel transplants in the tacrolimus era.
Main Methods:
- Retrospective review of pediatric small bowel patients listed since 1988 via the Canadian Organ Replacement Register.
- Inclusion of children referred to the program in its first year.
- Review of all pediatric small bowel transplants performed between January 1993 and December 1999.
Main Results:
- Mortality rate for pediatric patients on the small bowel transplant list was 53% (average 105 days on list).
- Patients who died on the list were younger with advanced liver disease.
- Overall 1-year patient and graft survival rates were 61% and 53%, respectively, for 13 Canadian pediatric recipients.
Conclusions:
- Many Canadian children are referred late for small bowel transplantation, missing opportunities for successful outcomes.
- A shortage of donor organs contributes to missed transplant opportunities.
- Survivors of pediatric small bowel transplantation achieve independence from total parenteral nutrition.
Purpose:
The mortality rate for pediatric patients on the waiting list for transplantation has a major impact on the overall effectiveness of pediatric small bowel transplantation. This review was undertaken to determine the fate of Canadian children assessed for small bowel transplant and the outcome of those who undergo transplant in the tacrolimus era.
Methods:
The authors reviewed retrospectively all of the pediatric small bowel patients listed since 1988 through the Canadian Organ Replacement Register and all the children referred to our program in its first year. All children who received a small bowel transplant between January 1993 and December 1999 also were reviewed.
Results:
The mortality rate for pediatric patients on the small bowel transplant list was 53% after an average of 105 days on the list compared with 212 days for those who underwent transplant. Patients who died while on the list were younger and had signs of advanced liver disease at the time of listing. Thirteen Canadian children have received a small bowel transplant with an overall 1-year patient and graft survival rate of 61% and 53%, respectively. Survivors are all independent from total parenteral nutrition.
Conclusion:
Many Canadian children miss their opportunity for a successful small bowel transplant because of late referrals and a shortage of donor organs.