Achieving Ideal Outcome After Intestinal Transplantation: How Close Are We?
1Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
2Intestinal Care and Rehabilitation Center, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Meeting: 2017 American Transplant Congress
Abstract number: A267
Keywords: Intestinal transplantation, Pediatric, Survival
Session Information
Session Name: Poster Session A: Small Bowel: All Topics
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Aim:To determine the incidence of factors affecting ideal outcome after pediatric intestinal transplantation (ITx).
Methods: Children that underwent primary ITx with intact grafts at one year were analyzed retrospectively under their immunosuppression groups for additional metrics of outcome including enteral autonomy, and lack of immunosuppressant morbidities.
Results: 243 children underwent primary ITx between 1990-2015. Patients with intact graft at one-year were 76%. Ten-year graft survivals by era were 21% (1990-94), 36% (1995-2000) and 56% (2001-15). Conditional one-year graft survival at 15 years for rATG and non-rATG groups were 68% and 39% respectively. 36 patients (45%) in non-rATG group were alive with intact graft and 25 of them are currently followed at mean 9.5 years. 92% had stoma closure and 96% are free of TPN-IVF. 84 patients (79%) in rATG group was alive with intact graft and 73 of them are currently followed at mean 8.3 years. 79% had stoma closure, 88% are free of TPN-IVF. Chronic rejection (68%) and PTLD were the major reasons for graft loss. Main causes of patient death were sepsis (41%), rejection and PTLD.
| Initial inductionimmunosuppression | rATGn (%) | non- rATG n (%) |
| Patients | 132 | 111 |
| Intact grafts at one year | 106 (80%) | 80 (72%) |
| Alive with intact graft | 84 (79%) | 36 (45%) |
| Alive with re-transplant | 5 (5%) | 5 (6%) |
| Alive with graft removed | 6 (6%) | 7 (8.7%) |
| Deceased | 16 (15%) | 37 (46%) |
| PTLD | 10 (9.4%) | 28 (35%) |
| Chronic rejection | 19 (18%) | 18 (22.5) |
| Subsequent renal transplantation | 5/73 (6.8%) | 0/25 |
| Enteral autonomy | 64/72 (88.8%) | 24/25 (96%) |
| Hypertension | 18/73 (24.6%) | 6/25 (24%) |
| Diabetes mellitus | 2/73 (2.7%) | 0/25 |
Conclusion:Improvement in long term survival and outcome in recent era may be attributed to improvements in technical modifications. In our experience conditional long term survival has also improved under rATG induction treatment. Chronic rejection, prevention and management of immunosuppressant related morbidities remain the most significant challenge to reach ideal outcomes.
CITATION INFORMATION: Ganoza A, Celik N, Bond G, Soltys K, Rudolph J, Sindhi R, Mazariegos G. Achieving Ideal Outcome After Intestinal Transplantation: How Close Are We? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Ganoza A, Celik N, Bond G, Soltys K, Rudolph J, Sindhi R, Mazariegos G. Achieving Ideal Outcome After Intestinal Transplantation: How Close Are We? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/achieving-ideal-outcome-after-intestinal-transplantation-how-close-are-we/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress