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Pediatric small bowel transplantation: A single-center experience from Turkey
Cem Tuğmen1, Maşallah Baran, İsmail Sert
1Department of Organ Transplantation and General Surgery, Sağlık Bilimleri University İzmir Tepecik Training and Research Hospital, İzmir, Turkey. mbaran2509@gmail.com.
Insights
Small bowel transplantation (SBTx) offers hope for intestinal failure patients. Challenges include managing acute cellular rejection and infections, with limited donor availability in Turkey impacting pediatric cases.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Gastroenterology
Background:
- Small bowel transplantation (SBTx) is a critical treatment for intestinal failure.
- İzmir Tepecik Training Research Hospital is Turkey's sole pediatric intestinal transplant center.
Purpose of the Study:
- To evaluate the outcomes of pediatric small bowel transplantation in Turkey.
- To identify challenges and successes in managing SBTx patients.
Main Methods:
- Retrospective analysis of seven isolated SBTxs in six pediatric patients (2010-2016).
- Data collected from medical charts and hospital databases.
- Grafts from deceased donors (one child, six adults).
Main Results:
- 1-year patient and graft survival rates were 71%.
- Acute cellular rejection (ACR) occurred in 57% of patients within 2 months.
- Infections (fungal, bacterial, EBV) were common, impacting outcomes.
Conclusions:
- SBTx is a viable option for pediatric intestinal failure.
- Managing ACR and infections remains a significant challenge.
- Limited availability of suitable cadaveric donors for pediatric SBTx in Turkey is a major hurdle.
Background/Aims:
Small bowel transplantation (SBTx) is a treatment option for patients with serious parenteral nutrition-related problems in intestinal failure. İzmir Tepecik Training Research Hospital Organ Transplantation Center is still the only pediatric intestinal transplant center in Turkey.
Material And Methods:
This study was approved by the local ethics committee. Patients' data were analyzed from the medical charts and the hospital digital database. Seven isolated SBTxs were performed in six children between 2010 and 2016.
Results:
One jejunal segment and six partial jejuno-ileal segments were used for seven transplants. All grafts were retrieved from deceased donors (one child and six adult donors). The six recipients had a mean age of 8.8±6.9 years (9 months to 17 years; M: 4, F: 2). The mean follow-up period of patients was 727±848 (34 to 1950) days. Acute cellular rejection (ACR) rates were 57% (n: 4) in the first 2 months. Graft loss due to severe ACR was seen in one patient. Central line-associated fungal (n: 3, 42%) and bacterial infections (n: 3, 42%) were seen in the first 2 months. Two Epstein-Barr virus (EBV) infections were recorded between 3 and 8 months in two patients. Our 1-year patient and graft survival rates were 71% and 71%, respectively.
Conclusion:
SBTx has become a treatment modality for patients with intestinal failures. Management of ACR and infections are still challenging problems in SBTx. Appropriate-sized cadaveric donors are very limited in Turkey for pediatric intestinal transplantation candidates. Although the number of SBTxs performed was small, this study shows promising results.