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Updated: May 21, 2026
Tissue Engineering of the Intestine in a Murine Model
Published on: December 1, 2012
Age-based disparity in outcomes of intestinal transplants in pediatric patients
C S Desai1, F B Maegawa, A C Gruessner
1Department of Surgery, University of Arizona, Tucson, AZ, USA. csdesai@gmail.com
Insights
Pediatric intestinal transplants show better patient survival with isolated ITx versus liver-ITx, especially for children over two years old. However, liver-ITx demonstrates superior graft survival long-term.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Intestinal failure is a critical condition in children requiring intestinal transplantation (ITx).
- Outcomes vary based on transplant type (isolated ITx vs. liver-ITx) and patient age.
- Long-term data on pediatric ITx outcomes are essential for clinical decision-making.
Purpose of the Study:
- To analyze and compare patient and graft survival rates for isolated ITx versus combined liver and ITx (L-ITx) in pediatric patients.
- To evaluate the impact of patient age on ITx outcomes.
- To provide evidence-based recommendations for the timing and type of ITx in children with intestinal failure.
Main Methods:
- Retrospective analysis of the United Network for Organ Sharing database (1987-2009).
- Inclusion of 977 pediatric intestinal transplant recipients.
- Stratification of patients into four age groups: <2, 2-6, 6-12, and 12-18 years.
- Comparison of survival outcomes between isolated ITx and L-ITx cohorts.
Main Results:
- Overall patient survival at 1, 3, and 5 years was significantly better for isolated ITx (85.3%, 71.3%, 65.0%) compared to L-ITx (68.4%, 57.0%, 51.4%) (p=0.0001).
- This survival advantage for isolated ITx was observed across all age groups except for those younger than 2 years.
- While isolated ITx showed better initial graft survival, L-ITx demonstrated superior long-term graft survival after the first year.
Conclusions:
- Isolated intestinal transplantation should be considered for children over two years old with intestinal failure, ideally before significant liver complications arise.
- For pediatric patients under two years old, isolated ITx may not offer a survival advantage.
- Combined liver and intestinal transplantation requires careful consideration regarding long-term graft outcomes in pediatric populations.
Abstract:
Outcomes of intestinal transplants (ITx; n = 977) for pediatric patients are examined using the United Network for Organ Sharing data from 1987 to 2009. Recipients were divided into four age groups: (1) <2 years of age (n = 569), (2) 2-6 years (n = 219), (3) 6-12 years (n = 121) and (4) 12-18 years (n = 68). Of 977 ITx, 287 (29.4%) were isolated ITx and 690 (70.6%) were liver and ITx (L-ITx). Patient survival for isolated ITx at 1, 3 and 5 years, 85.3%, 71.3% and 65.0%, respectively, was significantly better than L-ITx, 68.4%, 57.0% and 51.4%, respectively, (p = 0.0001); this was true for all age groups, except for patients <2 years of age. The difference in graft survival between isolated ITx and L-ITx was significant at 1 and 3 years (Wilcoxon test, p = 0.0012). After attrition analysis of graft survival of patients who survived past first year, 3 and 5 years, graft survival for L-ITx patient was significantly better than those for isolated ITx. Isolated ITx should be considered early before the onset of liver disease in children >2 with intestinal failure but is not advantageous in patients <2 years.
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