PEDIATRICS

D.A. Ramisch, R. Scaravonati, C. Rumbo, C. Echevarria, M.I. Martinez, H. Solar, F. Nachman, F. Klein, G. Orce, J. Trentadue, A. Cabanne, A. Fernandez, G. Gondolesi
Nutrition, Rehabilitation And Intestinal Transplant Unit, Fundación Favaloro, Buenos Aires/ARGENTINA

Body: INTRODUCTION: Standardization of surgical techniques, improvements in immunosuppression and the establishment of an experienced multidisciplinary team have allowed intestinal transplantation (ITx) to be successfully performed worldwide. Aim: to report the overall transplant program activity from 3/15/2006 to 31/01/2010 at the Nutrition, Rehabilitation and ITx Unit at Fundacion Favaloro, Argentina. METHODS: retrospective analysis of patients (pts) evaluated, listed and transplanted (Tx). Diagnoses, time on the waiting list, type of ITx and mean bowel length, mean total ischemia time (TIT) and warm ischemia time (WIT), immunosuppressive regime, early and late post-Tx re-operations, time for parenteral nutrition discontinuation (PND), 3-year actuarial patients survival are reported. RESULTS: 136 pts were referred to our program, 132 pts with intestinal failure, 43 were evaluated for ITx and 30 listed; 26 (86.6%) had short gut; 4 patients were referred for MTV tx without intestinal failure, 1 was resolved with liver transplant,1 listed, 2 under evaluation. Three patients died on the waiting list, 1 was rehabilitated, 5 are in waiting list; 22 received ITx and are analyzed: 18 isolated, 2 combined and 2 MTV; 8 adults (M: 37.4 ± 15.14 years) and 14 children (M: 7,54±4.97 years, Min: 13 months); 15 male. Mean time on the waiting list: 127 days (range: 2-484 days), 19 donors were CMV+. The mean length of transplanted intestine was 329.5 cm; TIT: 7:58±2:18 hs, WIT: 36.6±11.3 min. Anti-thymocyte Globulin-Tacrolimus-Sirolimus-Steroids were used in 3 multiorgan tx, in 3 IITX recipients transplanted with ABO compatible mismatch grafts and in 2 with positive B cell CxM; the others received Anti IL2mab-Tacrolimus-MMF-Steroids. Eleven/22(50%) pts needed early re-operations, 1 pt required a late operation for adhesions, 1 enterectomy for chronic rejection and 8 pts had the ostomy closed. Mean time for PND: 79±67 days. Mean length of hospital stay: 37±17 days. Deaths: 1 PNF of the liver, 1 exfoliative rejection, 1 CMV sepsis, 1 fungal endocarditis, 1 PTLD and 1 encephalitis Three years actuarial overall patient survival is 72%; 82% for IITx. CONCLUSION: In spite of the complexity of the procedure, our long term results show that currently, ITx is a valid option in south-America with comparable results to the last reports of the International Intestinal Registry and UNOS.

Disclosure: All authors have declared no conflicts of interest.