2011 - ISBTS 2011 Symposium

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Oral Communications 7: Complications

9.155 - Pre-transplant predictors of ICU, hospital length of stay and long term patient survival after intestinal transplantation in a single center

Presenter: Hector, Solar Muñiz, Buenos Aires, Argentina
Authors: Hector Solar1, Patricia Guimaraens1, Adriana Crivelli1, Javier Romero1, Carolina Rumbo1, Gabriel Gondolesi1

Pre-transplant predictors of ICU, hospital length of stay and long term patient survival after intestinal transplantation in a single center

Hector Solar, Patricia Guimaraens, Adriana Crivelli, Javier Romero, Carolina Rumbo, Gabriel Gondolesi

Instituto de Trasplante Multiorganico Unidad de Rehabilitación, Nutrición y Transplante Intestinal, Hospital Universitario - Fundación Favaloro, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina

Introduction: Outcome after intestinal transplantation (ITx) has improved over the last years as result of changes in surgical techniques; immunosuppression and close patient follow up among others. The aim of this study was to analyze the association of pre-ITx factors found at the time of the evaluation as predictors of post-ITx ICU length of stay (LOS), hospital LOS and patient survival in a single center.

Material and Methods: review of a prospectively  filled database including all patients who underwent a primary ITx or multiorgan Tx for intestinal failure from 3/2006 to 4/2011. Data collection consisted on 32 variables that were compared using chi-square and t- test, Cox regression model and Kaplan-Meier for actuarial survival using SPSS® v17.0.

Results: Data from 27/29 Tx patients were analyzed. Eigtheen were male, 18 children; 82% received isolated ITx, 18% multiorgan Tx (7% combined and 11% multivisceral). Median age was 6.17 years (0.8-15.6) for pediatrics and 41.8 years (18.6-58.9) for adults. Main intestinal failure etiologies were: volvulus 26%, Hirshprung’s disease 22%, gastrochisis 11%, ischemia 11%, others 30%. Forty one percent of the recipients had limited vascular accesses, being the main indication for ITx, followed by parenteral nutrition associated liver disease (22%) and central venous catheter infections (22%). The median time on waiting list: was 98 days (2-484). Of the 4 Multiorgan Tx, 2 died of primary graft non function on day 2 and 7 post transplant. One died with PTLD 112 days post transplant. The 3 years patient survival for the IITx group is 82%. In a univariate analysis was noted that younger recipient age (8.9±2.6 years), was associated with  longer hospital LOS (> 32 days) (p 0.02), while the lack of permeable vascular accesses at transplantation increased the ICU LOS  (> 10 days)(p 0.05). Hospitalization at time of ITx (p<0.002) and type of Tx (Multiorgan - p<0.001), were the only independent factors that manteined significance in the multivariate analyses.

Conclusion: Younger recipient age and lack of central venous accesses at the time of evaluation predict increased LOS at the time of ITx in our cohort of patients. In concordance with other single center reported experiences, to be hospitalized or to be  recipient of a multiorgan Tx impact the long term patient survival. 

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