Objective: To describe a single-center experience of pediatric living related small bowel transplantation (LRSBtx) and to provide an overview of the outcomes of the children who underwent this procedure.

Patients and Methods: This is a retrospective review of living related small bowel transplantation in children greater than 8 kg at the time of transplant. From October 2002 to January 2013, 13 LRSBtx were performed in 10 children (5 males and 5 females). Mean age was 2.7 years. Grafts transplanted included isolated small bowel (n = 7) and combined liver-small bowel (n = 6). Patient and graft survival, rejection, and incidence of post-transplant lymphoproliferative disorder (PTLD) were analyzed. A subanalysis of survival based on graft type was also performed.

Results: The overall 1-, 5- and 10 years patient survival was 90%, 80% and 70% and the overall graft survival at 1-, 5- and 10 years was 80%, 60% and 60% respectively. Subanalysis of the survival based on graft type; small-bowel-liver transplant (SB-Ltx) vs isolated small bowel transplant (iSBtx) was performed. A patient survival at 1-, 5- and 10- years of 83.4%, 67.7% and 67.7% was found in SB-Ltx group, compared to 100%, 75% and 75% patient survival in ISBtx group. Graft survival at 1-, 5- and 10 years was 50%, 50% and 50% compared to 100%, 75%, 75% respectively, for SB-Ltx and iSBtx groups. Seven children (70%) are currently alive with perfectly functioning graft without any requirement for TPN (6 with over 10 years follow-up and the other with 3 years follow-up). Only one case of rejection was observed throughout the study period (10%). The patient presented chronic rejection 33 months post-transplant and subsequent graft failure. Patient underwent retransplant which was complicated by recurrent severe rejections with graft loss and death due to sepsis 3 months after the second transplant. PTLD was diagnosed in 3 children with median onset at 5 months post-transplant (range 1-12 months); in all cases the children recovered with standard therapy.

Conclusion: Living donor small bowel transplantation is a feasible alternative to cadaveric donor small bowel transplantation for the treatment of irreversible intestinal failure to shorten waiting times and decrease the wait list mortality, with good long-term results.

CITATION INFORMATION: Garcia Aroz S, Tzvetanov I, Hetterman E, Hoonbae J, Spaggiari M, Oberholzer J, Testa G, John E, Benedetti E. Living Related Small Bowel Transplantation in Children – Patient and Graft Survival at 10 Years. Am J Transplant. 2016;16 (suppl 3).

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