Yaron Avitzur^1,2,3, Yu Jin Wang¹, Nicole de Silva³, Maria DeAngelis², David Grant², Vicky Ng^1,2, Nicola Jones^1,2, Paul Wales^2,3

¹Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada; ²Transplant Centre, Hospital for Sick Children, Toronto, Ontario, Canada; ³Group for Improvement of Intestinal Function and Treatment (GIFT), Hospital for Sick Children, Toronto, Ontario, Canada

Introduction: The outcome of children with intestinal failure has significantly improved over the last decade following the introduction of novel medical and surgical therapies by dedicated multidisciplinary intestinal rehabilitation programs (IRP). The aim of this study was to assess whether IRP also improves the outcome and affects the characteristics of intestinal transplant (IT) candidates.

Methods: A retrospective review of children assessed for IT (n=84). Comparisons were made between three time periods: before the establishment of our center’s IRP (GIFT) (BG; 1999-2002; n=33), early era of GIFT (EG; 2003-2005; n=18), and late era of GIFT (LG; 2006-2009; n=33) that reflect the full therapeutic impact of the program. Primary endpoints were patients’ listing outcome, current status, and cause of death. Secondary endpoints included etiology of IF, listing criteria, and liver function at listing.

Results: After the introduction of GIFT, more patients were treated with Serial Transverse Enteroplasty, and fish oil based lipid emulsion (Omegaven). The late era of GIFT was associated with an increase in patients who were not listed (42% LG vs. 27% BG, 28% EG), removed or held on the IT waiting list (36% LG vs. 3% BG, 6% EG), and a decrease in those who were transplanted (18% LG vs. 24% BG and 28% EG) or died before transplant (3% LG vs. 45% BG, 39% EG) (P<0.05). The cause of death shifted from traditional causes like liver failure or sepsis to other contributors related to co-morbid conditions (P>0.005). For current status, LG was associated with an increase in patients who are currently ‘on TPN’ or ‘free of TPN’ (P<0.001). Finally, a significant improvement in patients’ liver function at listing was also observed during LG (P<0.005).

Conclusions: Treatment by IRP reduces the number of children needing IT, improves survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.