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Published on: August 20, 2007
Late graft loss and long-term outcome after isolated intestinal transplantation in children
Insights
Late graft loss after pediatric intestinal transplantation is often due to rejection or sepsis. However, most children achieve nutritional independence from total parenteral nutrition (TPN) after successful intestinal transplantation.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Gastroenterology
Background:
- Isolated intestinal transplantation is a complex procedure for children with irreversible intestinal failure.
- Long-term graft survival and patient outcomes are critical metrics for evaluating transplant success.
Purpose of the Study:
- To investigate the causes of late graft loss following isolated intestinal transplantation in pediatric patients.
- To assess the long-term outcomes, including nutritional independence, in this cohort.
Main Methods:
- Retrospective analysis of pediatric patients who underwent primary isolated intestinal transplantation.
- Minimum follow-up of 1 year was required for inclusion.
- Graft survival, patient survival, and causes of graft loss were analyzed.
Main Results:
- Fifteen graft losses occurred in 28 children, with 7 losses happening 6+ months post-transplant.
- Late graft losses were attributed to sepsis (2), acute rejection (2), chronic rejection (2), and a stricturing process (1).
- All late survivors with functioning grafts achieved nutritional autonomy, discontinuing total parenteral nutrition (TPN).
Conclusions:
- Late graft loss, though a concern in a subset of patients, does not preclude long-term success.
- Nutritional independence from TPN is achievable for the majority of pediatric intestinal transplant recipients.
- Understanding late graft loss mechanisms is crucial for improving long-term outcomes in pediatric intestinal transplantation.
Background/Purpose:
The aim of this study was to determine causes of late graft loss and long-term outcome after isolated intestinal transplantation in children at a single center.
Methods:
All children who underwent primary isolated intestinal transplantation at our center with a minimum follow-up of 1 year were the subject of this retrospective study.
Results:
Twenty-eight children underwent primary isolated intestinal transplantation. Median graft survival was 705 days (range, 0 to 2,630 days) and median patient survival was 1,006 days (range, 0 to 2,630 days). There were 6 deaths and 15 graft losses (including the 6 nonsurvivors). Seven of the losses occurred 6 or more months after transplant. Of these, 2 losses occurred because of death of the recipients of sepsis; both recipients had functioning grafts. The 5 remaining late graft losses occurred because of acute rejection in 2 patients, chronic rejection in 2 (1 with concomitant acute rejection) and a diffuse stricturing process without the histologic hallmarks of chronic rejection in the fifth. All late survivors with intact grafts are off total parenteral nutrition (TPN).
Conclusions:
Late graft loss remains a concern in a small percentage of patients after isolated intestinal transplantation. Nutritional autonomy from TPN is possible in the majority of these children after transplantation.
