Background/aim: Pediatric intestinal transplantation has changed recently with more isolated small intestine transplants being performed in small children instead of combined liver-intestine transplants. Consequently, surgical techniques have changed, requiring a frequent use of vascular homografts of small caliber, the impact of which on outcomes is unknown.

Patients and Methods: Among 106 pediatric intestine and multivisceral transplants performed at our center since 2003, 39 recipients of an isolated small intestine graft were reviewed. Four patients transplanted between 2003 and 2005 with insufficient medical records and two patients with follow-up <1 year were excluded. The remaining 33 pts, including 4 retransplants (16M, 17F, median age 3.3 y [range 1.2-17.2], median weight 14.2 kg [8.1-56]) were included in this study. Grafts were monitored with Doppler of the stoma and angiography when necessary. Patients with hypercoagulable state received systemic anticoagulation from the time of graft reperfusion. Outcome parameters were thrombotic complications and graft survival.

Results: 25/33 grafts (76%) were reperfused “centrally” (aorta and vena cava), 24 of them via vascular homograft. The other 8 grafts were reperfused via native superior mesenteric artery and vein. Overall, 28/33 (85%) patients required both arterial and venous homografts from the same donor (donor's median age 1.1 y [2mo-23 y], median weight 10 kg [14.7-48.5]), mainly iliac or carotid artery and iliac or innominate vein, respectively.

Post-transplant, there were 3 acute thromboses at the anastomosis of the arterial homograft (2 central and one mesenteric) on post-operative day 0, 2 and 13 and one venous homograft thrombosis on POD 7 requiring urgent percutaneous thrombolysis and/or operative thrombectomy resulting in 2 peri-operative graft salvages and 2 graft losses. Three out of 4 thromboses occurred in patients with primary hypercoagulable state, including the 2 graft losses. Overall, at a median of 4.1 years (1-10.2) from transplant, 29/33 (88%) patients are alive with 26/33 (79%) functioning grafts.

Conclusion: In our series 2/33 (6%) pediatric isolated intestine grafts were lost due to thrombotic complications of the vascular homograft in patients with hypercoagulable state. The procurement of intact, size-matched donor vessels and post-transplant anticoagulation are critical.

CITATION INFORMATION: Kwon Y, Llore N, Girlanda R, Etesami K, Desai C, Matsumoto C, Fishbein T. Outcomes of Isolated Pediatric Small Intestine Transplants Using Vascular Homografts. Am J Transplant. 2016;16 (suppl 3).

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