Introduction: The treatment and management of Intestinal Failure (IF) has evolved into a highly specialized field which allows small infants and children the ability to be monitored and treated more effectively for the complications of total parenteral nutrition (TPN). We sought to evaluate the utilization of differing graft types in our smaller (<15kg) pediatric recipients over our entire 9 year center experience.

Methods: All recipients ≤ 15 kg were evaluated, and 2 equal eras were established from the inception of our program until November 2012.

Results: 84 pediatric (<18yo) intestinal transplants (ITx) were performed over a 9 year period in 82 recipients.  63 cases were performed in 62 recipients ≤ 15kg.  34 cases were performed in the first half of our experience (Era 1) and 29 in the second half experience (Era 2).  Distribution of liver-inclusive grafts and demographics are listed in Table 1. There was a significant decrease (p = 0.002) in the need for liver-inclusive grafts in smaller infants and children in the latter years of our center experience. Average weight was significantly greater in later era recipients (p = 0.013) and there was a trend towards older recipients in the later era  (p = 0.076).  In these smaller sized isolated ITx cases, central (IVC) outflow and direct aortic inflow was employed in 13/14 (92.9%) cases.  Vascular conduits were utilized in all cases with venous conduits comprised of the donor vessels: common iliac vein (8), innominate vein (3), jugular vein (2), and IVC (1). Arterial conduits were the donor carotid artery (8) and iliac artery (6). One case utilized the recipient mesenteric vessels as inflow and outflow with iliac artery and vein conduits.

Conclusion: There has been a significant decreased trend in the use of liver-inclusive grafts in smaller infants and children in ITx.  The wider use of “hepatic-sparing” TPN formula as well as the adjunct use of alternative lipid emulsions may have altered the demographics of those smaller ITx recipients with intestinal failure. The significant increase in recipient weight between the 2 eras may be an observed response to the changing demographics of graft composition and indications for ITx in infants and children. 

 

 

	n (cases)	Age (yrs)	Wt (kg)	Liver (+)	Liver( -)
Era 1	34	1.46 ± 1.06	9.08 ± 2.60	32	2
Era 2	29	2.04 ± 2.13	10.63 ± 2.74	17	12