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Updated: Aug 6, 2026
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Expanded use of multivisceral transplantation for small children with concurrent liver and intestinal failure
1Divisions of Transplant, Pediatric Gastroenterology, Pediatric Critical Care Medicine, and Immunopathology, University of Miami, School of Medicine, 1801 NW 9th Avenue, Miami, FL 33136, USA. tkato@med.miami.edu
Insights
Multivisceral transplantation (MVT) in children significantly improved survival and reduced rejection rates after 2001. Expanding MVT use offers a viable alternative for liver-intestine-pancreas transplant candidates.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Gastroenterology
Background:
- Liver and intestinal failure in children necessitates complex transplantation procedures.
- Multivisceral transplantation (MVT) evolved from a selective approach to broader application.
- Daclizumab induction therapy has been used since 1998.
Purpose of the Study:
- To compare outcomes of pediatric multivisceral transplantation (MVT) before and after 2001.
- To evaluate the impact of expanded MVT use on patient survival and rejection rates.
- To assess the safety and efficacy of MVT as an alternative to liver-intestine-pancreas transplantation.
Main Methods:
- Retrospective analysis of 55 pediatric patients undergoing transplantation since 1998.
- Group 1: 19 patients (pre-2001) with limited MVT use.
- Group 2: 36 patients (post-2001) with expanded MVT use.
Main Results:
- Significantly higher 6-month, 1-year, and 2-year patient survival in Group 2 (94%, 91%, 71%) compared to Group 1 (54%, 37%, 32%).
- Group 2 showed improved freedom from rejection (P = .0019) with no deaths due to rejection, unlike Group 1 (21% mortality).
- Gastro-gastric anastomosis in recent MVT cases showed no complications; no pancreatic rejection observed.
Conclusions:
- Expanded use of multivisceral transplantation (MVT) in pediatric patients dramatically improves survival and reduces rejection.
- MVT is a safe and effective alternative to liver-intestine-pancreas transplantation for children with visceral failure.
- Small children tolerate MVT well, supporting its wider consideration in treatment protocols.
Abstract:
Fifty-five children with liver and intestinal failure have been transplanted at our center under daclizumab induction therapy since 1998. Of those, 19 received five multiviceral transplantation (MVT), 12 liver-intestine-pancreas transplants, and 2 noncomposite liver and intestine transplants (NCLIT) before 2001 (group 1). During this period, MVT was only used in children with gastric dysmotility. After 2001, we expanded the use of MVT. Therefore, 36 children in this period (group 2) received MVT except for two who received NCLIT. Median age was 1.08 in group 1 and 1.06 in group 2. Median recipient weight was 8.2 kg in group 1 and 7.5 kg in group 2. Six-month, 1-, and 2-year patient survivals were 54%, 37%, and 32% in group 1 and 94%, 91%, and 71% in group 2 (P = .00037). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019) Four died of rejection in group 1 (21%); none died of rejection in group 2. There have been two esophago-gastrostomy strictures (one in each group) and a serious reflux of this anastomosis (group 2). Strictures were treated with balloon dilatation, and the reflux was surgically corrected. In 24 recent cases, gastro-gastric anastomosis was used in MVT with no complications to date. No pancreatic rejection was seen. Small children tolerated MVT with improved survival rates and reduced rates of rejection. Use of MVT may be considered as an alternative to liver-intestine-pancreas transplant.
