2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.4 - Gastroschisis related intestinal failure: Does it increase risk for intestinal transplantation?

Presenter: Vinay, Bandla, , United States
Authors: Vinay Bandla¹, Jane Zhao², Alex Olsen^1,1,2, Cynthia Bell^1,3, Essam Imseis¹, Stacey Moore-Olufemi²

Gastroschisis related intestinal failure: Does it increase risk for intestinal transplantation?

Vinay Bandla¹, Jane Zhao², Alex Olsen^1,1,2, Cynthia Bell^1,3, Essam Imseis¹, Stacey Moore-Olufemi²

¹Pediatric Gastroenterology , UT Houston, Houston, TX, United States; ¹Hepatobiliary, Pancreas, Transplantation and Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan; ¹Gastroenterology and Intestinal Failure, Beaujon hospital, Clichy, No, France; ¹Gastroenterology and Intestinal Failure, Beaujon hospital, Clichy, No, France; ²Pediatric Surgery, UT Houston, Houston, TX, United States; ³Biostatistics, UT Houston, Houston, TX, United States

Aim of the study: Gastroschisis is known to result in intestinal failure (IF) and is the leading cause of intestinal transplantation (IT) in the US today. The purpose of this study was to look at the development of IF and need for transplantation among simple and complex gastroschisis patients.

Methods: We conducted a retrospective review from 2004-2012 of a prospective gastroschisis database maintained at our institution. 89 patients were identified and categorized into simple (intact, uncompromised continuous bowel) and complex (perforation, necrosis or atresia) gastroschisis. We evaluated the following outcomes: development of IF (> 60 days of TPN), need for IT, time to reach autonomous enteral feeds, duration of hospital stay, sepsis related events and death. Results are expressed in terms of standard error of mean, confidence intervals (CI) and interquartile ranges (IQR)

Main Results: 20% of the 89 infants in our cohort with gastroschisis were categorized to the complex group. 80% of the complex gastroschisis patients developed IF vs 12% in the simple group (p<.001). There was no difference in development of IF between those with primary v delayed closure (p=.17). The Complex gastroschisis patients had a significantly longer duration of TPN(106 days CI (73-248) (Fig.1) and hospital stays (139.5 days (IQR 55, 255)) when compared to the simple group (TPN: 24 days (CI 20-30) hospital stay: 32 (IQR 23, 45)). There was significantly more sepsis-related events among the complex group (p=0.003); however there was no difference in the 30-day mortality.

Conclusions: Complex gastroschisis patients have a higher incidence of IF and sepsis related events. No one in our cohort needed transplantation. This data suggests that we need more prospective studies to properly identify which cohort of gastroschisis patients go on to IT.

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