2011 - ISBTS 2011 Symposium


Oral Communications 6: Surgical Aspects of ITX

8.149 - Impact of perioperative parameters on outcomes after paediatric intestinal and multivisceral transplantation

Presenter: Cristina, Dopazo, BARCELONA, Spain
Authors: Cristina Dopazo1, Girish Gupte2, Ahmed Taha2, Paolo Muiesan2, Jane Hartley2, Peter Bromley3, James Bennett3, Susan V. Beath2, Deirdre A. Kelly2, Khalid Sharif2, Darius F. Mirza2


149
Impact of perioperative parameters on outcomes after paediatric intestinal and multivisceral transplantation

Cristina Dopazo1, Girish Gupte2, Ahmed Taha2, Paolo Muiesan2, Jane Hartley2, Peter Bromley3, James Bennett3, Susan V. Beath2, Deirdre A. Kelly2, Khalid Sharif2, Darius F. Mirza2

1Department of HPB Surgery and Transplants, Hospital Vall d´Hebron, Barcelona, Spain; 2Liver Unit (including small bowel transplantation), Children´s Hospital, Birmingham, United Kingdom; 3Anaesthetic Department, Children´s Hospital, Birmingham, United Kingdom

Intestinal transplantation (with or without the liver) can have significant haemodynamic and metabolic demands on recipients.

Aim: To analyse the impact of pre-operative status and intra-operative metabolic events on outcome during the first six months post-intestinal transplantation.

Patients and Methods: 51 primary small bowel transplants (12- isolated intestinal transplant (IITx group) and 39- combined liver-intestinal transplant (CLITx group)) were included. Risk factors for early mortality analysed included recipient, donor, operative and post-operative variables.

Results:

 

IITX

Median (range)

CLITX

Median (range)

Age

52 months

(21-141)

18 months

(8-194)

Cold ischemia time

380 min

(221-540)

449min

(265-740)

Warm ischemia time

29 min

(21-45)

40 min

(29-66)

BE 30min post-reperfusion

-12.5

(-18.4 - -4)

-6.8

(-22.6 - -5)

Early complications (vascular complications, compartment syndrome, acute rejection) were higher in CLITx. Ten patients (19%, all in CLITx group) died in first six months.

In univariate and multivariate analyses, the factors showing independent predictive value for early mortality in CLITx group were:

  1. Recipient data: GI bleeding in preceding 3 months, hospitalisation at time of ITx
  2. Donor data: no significant variables
  3. Intra-operative data:  blood transfusion >70ml/Kg (OR 14, p0.019) and BE 30 min post-reperfusion <-16 (OR 14, p0.001)
  4. Post-transplant data: thrombocytopenia day 1-15 (OR 6, p0.024) and vascular complications (OR 7, p0.005)

Conclusion: CLITX patients with metabolic acidosis and persistently low platelet count (<50,000/dL) should be monitored closely in the first 6 months. 


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