2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.18 - Early and late complications in very late survivors after small bowel transplantation

Presenter: Olivier, Corcos, , France
Authors: Olivier Corcos1, Olivier Goulet2, Francisca Joly1, Christophe Chardot7, Dominique Cazals-Hatem4, Yann Revillon2, Vanessa Bondjemah1, Alexandra Bisbal1,2, Cecile Talbotec2, Safi Dokmak3, Amelie Toussaint6, Leon Maggiori5, Catherine Paugam6, Yves Panis5, Yoram Bouhnik1, Florence Lacaille2

Early and late complications in very late survivors after small bowel transplantation

Olivier Corcos1, Olivier Goulet2, Francisca Joly1, Christophe Chardot7, Dominique Cazals-Hatem4, Yann Revillon2, Vanessa Bondjemah1, Alexandra Bisbal1,2, Cecile Talbotec2, Safi Dokmak3, Amelie Toussaint6, Leon Maggiori5, Catherine Paugam6, Yves Panis5, Yoram Bouhnik1, Florence Lacaille2

1Gastroenterology and Intestinal Failure, Beaujon hospital, Clichy, France; 2Pediatric Hepatogastroenterology-Nutrition, Necker-Enfants Malades Hospital, Paris, France; 3Hepatobiliary and pancreatic Surgery and liver Transplantation, Beaujon Hospital, Clichy, France; 4Pathology, Beaujon Hospital, Clichy, France; 5Colorectal Surgery and Intestinal Transplantation, Beaujon Hospital, Clichy, France; 6Surgical Reanimation Unit, Beaujon Hospital, Clichy, France; 7Pediatric Surgery Unit and Transplantation, Necker-Enfants Malades Hospital, Paris, France

Introduction : Very late survival is possible after SBT. No data exist concerning early and late complications encountered by very late survivors (VLS). We aimed to report these complications in VLS.

Patients & Methods : From our cohort of 97 children who received 105 SBT in Necker-Enfants Malades Hospital, Paris, followed at the adult age in Beaujon Hospital, Clichy, France we selected all survivors>10 years after SBT. We retrospectively studied early/late complications, including infectious/non infectious and abdominal/extradigestive complications.
Results : FromMarch 1989 to december 2012, 26 (18 male/8 female) patients were selected for the study, 19 with and 7 without intestinal graft. SBT consisted in L-SBT n=19, isolated SBT n=7, including colon n=16. In 19 VLS with functional graft, induction protocole included basiliximab (n=6) or steroids +/-ciclosporin (n=13). Maintenance IS protocol included tacrolimus/steroids (n=19), mycophenolate (n=4) or rapamycine (n= 2).  At the end of  follow-up 21 patients were still alive with  (n=19) a functioning intestinal graft or after graft loss (n=2).
11/26 patients (42%) experienced postoperatory complications : severe abdominal wall infections, biliary complications, fistulae, volvulus, peritonitis, pancreatitis or major bleeding. Severe infectious complications occured in 17 patients (65%) : bacterial (n=4) ; CMV n=6, EBV n=7, non-CMV viral infections (n=6) ; pneumocystis jiroveci (n=1), candidemia (n=1) or multiagent infections (n=4). Late non-infectious complications were observed in 19 cases (73%): abdominal complications (n=12, liver rejection n=7, graft colitis n=6, cirrhosis n=2, mesenteric ischemia, fistulae, septic chock, lymphoma, biliary stenosis, CDiff colitis, enteric infections) and extradigestive complications (n=15, arterial hyperpressure n=3, PTLD n=5, osteoporosis n=7, renal failure, epilepsy, hypereosinophilic syndrom, auto-immune hemolytic anemia, thoracic complications). Acute or chronic rejections were observed in 13 (50%) and 2 cases (8%), respectively.
Conclusion : Despite various, frequent and severe early/late complications, SBT recipients may have very late survival, even after graft loss. 

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