2013 - ISBTS 2013 Symposium

This page contains exclusive content for the member of the following sections: TTS, IXA, ITA. Log in to view.

Mini-Oral Communications 1

12.242 - Paediatric intestinal transplantation in the modern era: King's College Hospital Experience

Presenter: Eirini, Kyrana, , United Kingdom
Authors: Eirini Kyrana¹, Anil Dhawan¹, Babu Vadamalayan¹, Hector Vilca-Melendez¹, Nigel Heaton¹, Jutta Koglmeier², Jonathan Hind¹

Paediatric intestinal transplantation in the modern era: Kingâ€™s College Hospital Experience

Eirini Kyrana¹, Anil Dhawan¹, Babu Vadamalayan¹, Hector Vilca-Melendez¹, Nigel Heaton¹, Jutta Koglmeier², Jonathan Hind¹

¹Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, United Kingdom; ²Gastroenterology and Nutrition Centre, Great Ormond Street Hospital, London, United Kingdom

Introduction

We established an intestinal transplant service in 2009 in collaboration with a tertiary intestinal rehabilitation centre (Great Ormond Street Hospital) to complement surgical and medical strengths of both units. We report our 4 year experience.

Results

From August 2009- February 2013 10 children (5 male) underwent transplantation at median age 5 years (range 0.5-16). Diagnoses: short gut syndrome (gastroschisis (3), strangulated diaphragmatic hernia (1)), Chronic intestinal pseudo-obstruction (3), intestinal lymphagiectesia (1), microvillous inclusion disease (1) and antenatal midgut volvulus with biliary atresia splenic malformation (1). 8 received isolated small bowel (SB), 2 combined liver and SB.

Immunosuppression: ATG was given to the donor in the first 4 transplants. All had basiliximab induction with Tacrolimus and prednisolone maintenance. Sirolimus was added to all isolated bowel transplant recipients after 1 month but stopped in 7 of 8 due to neutropenia. 1 on azathioprine. 3 patients were given infliximab due to ongoing graft inflammation without apoptosis. 1 improved after 2 doses, 2 improved and remain on 8 weekly doses.

Complications:

Two patients developed severe acute cellular rejection treated with ATG. One responded, one died from sepsis after graft removal.

4 patients developed post transplant lymphoproliferative disease. All were treated successfully. Three with rituximab, one with chemotherapy.

One patient developed severe adenovirus infection. One had cryptosporidium requiring short-term parenteral nutrition.

No episodes of GvHD.

After a median follow-up of 2.5 years (range 0.5-3.5) 9 patients are at home with their original graft and have returned to nursery, school or work. 7 take full enteral feeds, 2 have 30% calorie requirement parenterally (both weaning). 1 patient died at 8 months post transplant.

Conclusion:

An intestinal transplantation programme set up in units with liver transplant and intestinal rehabilitation experience can achieve excellent results comparable to large centres.

By viewing the material on this site you understand and accept that:

The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
The material is solely for educational purposes for qualified health care professionals.
The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
The information cannot be used as a substitute for professional care.
The information does not represent a standard of care.
No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada

Member Login