Introduction : Small bowel transplantation (SBT) is offered to patients with irreversible life-threatening intestinal failure. Progresses in management in anesthesiology, surgery, immunology, infectiology and knowledge in intestinal graft functions, have allowed improvement in early and late survival. However no data exist concerning outcomes of very late survivors, beyond ten years.

 

Methods :From our cohort who received a SBT in Necker-Enfants Malades Hospital, Paris and followed at the adult age in Beaujon Hospital, Clichy, France, we selected all survivors over 10 years, irrespective to graft survival. Study period was comprised between the date of SBT to death or last follow-up. In this study we aimed to determine the outcome of late survivors after SBT.

 

Results : From our cohort of 97 children with intestinal failure who received,from March 1989 to december 2012, 105 SBT 26 (18 male/8 female) were still alive ten years after SBT (27%) . Median age at transplantation was 4,6 years. Intestinal transplantation consisted in L-SBT n=19, isolated SBT n=7, including colon n=16. Anti-rejection induction protocoles included steroids+/- ciclosporin (n= 17, before dec 1999) or basiliximab (n=9). During follow-up (15 y), 5 children died 10,6 years after SBT. 15 (14-24) years after SBT 21 patients were still alive (81%) with a mean age of 20 (13-28) years, 19 with intestinal graft. After a mean of 4 years (4d-9,4y), 9 children experienced graft loss, from acute rejection (n=3), chronic rejection (n=1), primary graft failure (n=2), infection (n=2), ischemia (n=1). Finaly 19 patients (73%), including 3 retransplanted patients still had functionning SB transplant at the end of follow-up. 5/9 patients who experienced graft loss were alive 14 years after, 2 with SBS/PN and 3 retransplantations.

 

Conclusion : Our study demonstrates that very late survival is possible after SBT, even in case of graft removal. Factors associated with very late survival should be studied further.