2011 - ISBTS 2011 Symposium


Oral Communications 7: Complications

9.158 - A 10 year experience of medical complications in paediatric small bowel transplantation

Presenter: Jane, Hartley, Birmingham, United Kingdom
Authors: Jane Hartley1, Girish Gupte1, Sue Beath1, Paulo Muiesan2, Deirdre Kelly1, Indra van Mourik1, Patrick Mckiernan1, Darius Mirza2, Khalid Sharif1


158
A 10 year experience of medical complications in paediatric small bowel transplantation

Jane Hartley1, Girish Gupte1, Sue Beath1, Paulo Muiesan2, Deirdre Kelly1, Indra van Mourik1, Patrick Mckiernan1, Darius Mirza2, Khalid Sharif1

1Birmingham Children's Hospital, Birmingham, United Kingdom; 2Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom

Historically the outcome of children undergoing small bowel transplant has been affected by multiple complications.

Aim: To review the medical complications occurring in an experienced paediatric small bowel transplant centre over a 10 year period in order to develop appropriate preventive strategies .

Subjects and Methods: Retrospective analysis of 50 children undergoing 55 small bowel transplants (5 re transplant) between January 2000 -December 2010 (40 -combined small bowel and liver transplant, 2 -modified multivisceral transplant and 13 - isolated small bowel transplant).

Results: The table provides a summary of the complications.

Complication (number of episodes)

< 3 months

>3 months

Infection (106)

11 central venous line

8 wound

8 chest

7 enteritis

16 EBv viraemia

27 viral enteritis

19 EBV viraemia

7 oesophageal candidiasis

 

Acute Rejection (60)

7 severe

6 severe

Chronic rejection (5)

0

5 with 3 requiring enterectomies

Pancreatitis (5)

3 following re transplant

1 primary transplant

1  following treatment for GvHD

Endocrine (6 insulin need)

3 transient

1 long term

2 transient following treatment for acute rejection

Haematological (23)

2 GvHD

4 autoimmune haemolysis

3 GvHD

1 autoimmune haemolysis

14  neutropenia

Neurological (8)

 3 seizures

1 fixed dilated pupils

1 Cerebellar fungal lesion

1 Brain PTLD

3 posterior reversible encephalopathy

1 myalgic encephalomyelitis

Renal (29)

3 required CCVH:-

-2 initially post transplant

-1 following sepsis

12 reduced creatinine clearance

14 hypertension

Post transplant lymphoproliferative disease (10)

1

9

Discussion: The incidence of viral gastroenteritis, hypertension, neutropenia and severe rejection late post transplant are complications in which the high incidence requires heightened monitoring and further investigation for therapeutic options.

Conclusion: An awareness of the potential complications and the timing for heightened vigilance will aid prompt treatment of complications in future transplants and improve long-term survival.


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