This page contains exclusive content for the member of the following sections: TTS, ITA. Log in to view.
Presenter: Robert, Venick, Los Angeles, United States
Authors: Robert Venick1,2, Sue McDiarmid1,2, Laura Wozniak1, Yvonne Esmailian2, Vilayphone Hwang2, Susan Ponthieux2, Ronald Busuttil2, Douglas Farmer2
Robert Venick1,2, Sue McDiarmid1,2, Laura Wozniak1, Yvonne Esmailian2, Vilayphone Hwang2, Susan Ponthieux2, Ronald Busuttil2, Douglas Farmer2
1Department of Pediatrics, UCLA, Los Angeles, CA, United States; 2Department of Surgery, UCLA, Los Angeles, CA, United States
Background: Intestinal graft function has been well chronicled following combined Liver-inclusive-Intestinal Transplantation (LiITx) . The aim of this study was to describe in detail liver dysfunction following LiITx.
Methods: We conducted an IRB-approved, retrospective, single-center cohort study of all pediatric LiITx recipients with > 6 mo graft survival. Liver function tests were collected serially post- LiITx. Graft dysfunction was defined as ALT>100 (U/L), or T or D bilirubin >2.0 or > 1.0 (mg/dL) respectively. 20 demographic & clinical variables related to nutrition, surgery, immunosuppression, hospitalization & infection were analyzed using Chi-square methods as potential predictors of graft dysfunction.
Results: Between November 1991- May 2011, 45 children who received 49 LiITx met inclusion criteria. Leading indications for LiITx =gastroschisis (32%) & NEC (18%). Mean age at LiITx =4.2±4.4 yrs, follow-up time= 4.8± 3.7 years, cold & warm ischemia time (C&WIT)= 7.0 ±1.9 & 0.6 ± 0.2 hours, tube feeds were started = 7.5 ± 3.1 days & TPN was weaned off = 34 ± 24 days post- LiITx. Liver function tests are shown in Table 1. The percentage of patients with liver dysfunction post- LiITx were: Day+7 =76%, Day +30= 31%, Day +180= 9%, Day +365= 7%
Predictors of graft dysfunction at +30 days were: sepsis (p=0.04) & WIT > 60 minutes (p=0.08); predictors at +180 days were: age at LiITx <2 y/o (p=0.05) & >100 hospitalization days (p=0.04).
61 percutaneous liver biopsies were performed during the first year post- LiITx. At the time of biopsy 60% of patients had evidence of liver & intestinal graft dysfunction vs. 40% had liver only dysfunction. 13% (n=8)of biopsies revealed acute cellular rejection (ACR) of the liver graft.
Conclusions: Liver function following pediatric LiITx is excellent. ACR of the liver is relatively uncommon. If it occurs it tends to be in the first 60 days post- LiITx & is associated with sepsis and prolonged WIT.
Table 1 Median liver function tests in year 1 following Liver-inclusive-Intestinal Transplantation (LiITx).
|
ALT (U/L) |
T/ D Bilirubin (mg/dL) |
Alkaline Phosphatase (U/L) |
Albumin (g/dL) |
Pre-LiITx |
115 |
15.5/ 8.9 |
197 |
2.8 |
Day +3 |
148 |
3.7/ 2.3 |
72 |
2.8 |
Day +7 |
47 |
3.0/ 1.4 |
96 |
2.7 |
Day +30 |
33 |
1.4/ 0.5 |
255 |
2.9 |
Day +180 |
21 |
0.4/ 0.1 |
179 |
3.5 |
Day +365 |
28 |
0.2/ 0.1 |
165 |
3.3 |
By viewing the material on this site you understand and accept that:
The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada