2016 - IPTA Fellows Meeting


Mini-Oral Abstract Presentations

14.44 - Conditional long term intestine patient and graft survival is improving under rATG immunosuppression in pediatric intestine transplantation

Presenter: Frederick, Vyas, Pittsburgh, United States
Authors: Frederick Vyas, Neslihan Celik, Geoffery Bond, Kyle Soltys, Jeffrey Rudolph, Rakesh Sindhi, George Mazariegos


Conditional long term intestine patient and graft survival is improving under rATG immunosuppression in pediatric intestine transplantation

Frederick Vyas1, Neslihan Celik1, Geoffery Bond1, Kyle Soltys1, Jeffrey Rudolph2, Rakesh Sindhi1, George Mazariegos1.

1Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; 2Intestinal Care and Rehabilitation Center, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States

Title
Conditional long term intestine patient and graft survival is improving under rATG immunosuppression in pediatric intestine transplantation 
Aim
We reviewed conditional graft survival and short and long term improvements in children receiving rATG (rabbit anti-thymocyte globulin) immunosuppression at a single center over 15 years.
Methods
All children undergoing primary intestine transplantation under rATG and non rATG immunosuppression were analyzed. rATG immunosuppression was with 5 mg/kg rATG/ Tacrolimus/ Prednisolone (n=126) and other immunosuppression consisting of Tacrolimus/ Prednisolone (n=50), Tacrolimus/ Prednisolone/ Daclizumab (n=23), Tacrolimus/ Prednisolone/ Cyclophosphamide (n=16), Alemtuzumab (n=21) and Tacrolimus/ Prednisolone/ Basiliximab (n=1). Patients with intact grafts at one year were followed for subsequent long term outcomes of patient and graft survival, retransplant outcomes and significant morbidities.
Results
242 children underwent primary intestine transplantation between 1990 and 2015 consisting of isolated small bowel (n=94, 39%), liver and small bowel (n=109, 45%), modified multivisceral (n=7, 3%) and multivisceral type transplantations (n=32, 13%). The major causes of intestinal failure were gastroschisis (n=62, 26%), volvulus (n=51, 21%), necrotizing enterocolitis (n=28, 12%), pseudo obstruction (n=30, 12%), intestinal atresia (n=23, 10%), microvillus inclusion disease (n=17, 7%) and Hirschprung's Disease (n=16, 7%). Conditional graft survival at 15 years for rATG and non rATG groups is illustrated in Figure 1.

Subsequent outcomes in patients with intact graft at one year

Initial induction immunosupression

rATG n

 

non-rATG n
Patients 126 111
Intact grafts at one year 105/126 (83%) 80/111 (72%)
Alive with intact graft 80 (76%) 34 (43%)
Alive with retransplant 7 (7%) 5 (6%)
Alive with graft removed 4 (4%) 6 (8%)
Deceased 17 (16%) 37 (46%)
PTLD 13/126 (10.3%) 36/111 (32.4%)
Chronic rejection 20/126 (16%) 21/111 (19%)

Conclusion
Conditional long term survival in intestine transplantationhas improved under rATG in our experience. Chronic rejection remains the most significant challenge to more dramatic improvements in long term outcomes.

 

 

 

 


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