TY - JOUR
T1 - Lessons learned in pediatric small bowel and liver transplantation from living-related donors
AU - Gangemi, Antonio
AU - Tzvetanov, Ivo G.
AU - Beatty, Elizabeth
AU - Oberholzer, Jose
AU - Testa, Giuliano
AU - Sankary, Howard N.
AU - Kaplan, Bruce
AU - Benedetti, Enrico
PY - 2009/4/15
Y1 - 2009/4/15
N2 - BACKGROUND.: Children are the primary candidates for intestinal transplant with more than 70% requiring a combined liver-bowel transplant. We report our single-center experience with living donor intestinal transplantation (LDITx) and combined living donor intestinal and liver transplant (CLDILTx) in pediatric patients. PATIENTS AND METHODS.: Between October 2002 and June 2006, 13 living donor intestinal grafts were transplanted in 10 recipients. In five cases CLDILTx was performed. The intestinal grafts consisted of a 150-cm segment of ileum, whereas the liver transplant was completed using standard left lateral grafts. RESULTS.: No complications occurred in any donors. In CLDILTx recipients, the patient survival at 1 and 2 years was 100%, the liver graft survival 100%, and the bowel graft survival 80%; the patient who lost the initial intestinal graft was successfully retransplanted. In LDITx recipients, the patient and graft survival at 1 and 3 years were 60% and 50%, respectively. Two isolated LDITx recipients, both 6 months of age and low body weight (mean, 6 vs. 9 kg) died within 4 months posttransplant. One LDITx recipient developed chronic rejection 3.5 years after the original transplant and died after retransplant. All patients who are alive with functioning grafts are currently on full enteral feeding without need for any intravenous supplementation, except for a recipient of CLDILTx, currently on total parenteral nutrition for late fistula. CONCLUSIONS.: The early outcomes of intestinal transplantation from living donors are promising, particularly for candidates in need of CLDLITx. In this subgroup, the elimination of the high mortality on the cadaver waiting list (̃1/430%) represents a substantial advantage.
AB - BACKGROUND.: Children are the primary candidates for intestinal transplant with more than 70% requiring a combined liver-bowel transplant. We report our single-center experience with living donor intestinal transplantation (LDITx) and combined living donor intestinal and liver transplant (CLDILTx) in pediatric patients. PATIENTS AND METHODS.: Between October 2002 and June 2006, 13 living donor intestinal grafts were transplanted in 10 recipients. In five cases CLDILTx was performed. The intestinal grafts consisted of a 150-cm segment of ileum, whereas the liver transplant was completed using standard left lateral grafts. RESULTS.: No complications occurred in any donors. In CLDILTx recipients, the patient survival at 1 and 2 years was 100%, the liver graft survival 100%, and the bowel graft survival 80%; the patient who lost the initial intestinal graft was successfully retransplanted. In LDITx recipients, the patient and graft survival at 1 and 3 years were 60% and 50%, respectively. Two isolated LDITx recipients, both 6 months of age and low body weight (mean, 6 vs. 9 kg) died within 4 months posttransplant. One LDITx recipient developed chronic rejection 3.5 years after the original transplant and died after retransplant. All patients who are alive with functioning grafts are currently on full enteral feeding without need for any intravenous supplementation, except for a recipient of CLDILTx, currently on total parenteral nutrition for late fistula. CONCLUSIONS.: The early outcomes of intestinal transplantation from living donors are promising, particularly for candidates in need of CLDLITx. In this subgroup, the elimination of the high mortality on the cadaver waiting list (̃1/430%) represents a substantial advantage.
KW - Combined liver bowel transplant
KW - Intestinal transplantation
KW - Living-related donor
UR - http://www.scopus.com/inward/record.url?scp=65549117822&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=65549117822&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e31819cc3bf
DO - 10.1097/TP.0b013e31819cc3bf
M3 - Article
C2 - 19352122
AN - SCOPUS:65549117822
SN - 0041-1337
VL - 87
SP - 1027
EP - 1030
JO - Transplantation
JF - Transplantation
IS - 7
ER -