2011 - ISBTS 2011 Symposium
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Oral Communications 7: Complications
9.158 - A 10 year experience of medical complications in paediatric small bowel transplantation
Presenter: Jane, Hartley, Birmingham, United Kingdom
Authors: Jane Hartley1, Girish Gupte1, Sue Beath1, Paulo Muiesan2, Deirdre Kelly1, Indra van Mourik1, Patrick Mckiernan1, Darius Mirza2, Khalid Sharif1
A 10 year experience of medical complications in paediatric small bowel transplantation
Jane Hartley1, Girish Gupte1, Sue Beath1, Paulo Muiesan2, Deirdre Kelly1, Indra van Mourik1, Patrick Mckiernan1, Darius Mirza2, Khalid Sharif1
1Birmingham Children's Hospital, Birmingham, United Kingdom; 2Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
Historically the outcome of children undergoing small bowel transplant has been affected by multiple complications.
Aim: To review the medical complications occurring in an experienced paediatric small bowel transplant centre over a 10 year period in order to develop appropriate preventive strategies .
Subjects and Methods: Retrospective analysis of 50 children undergoing 55 small bowel transplants (5 re transplant) between January 2000 -December 2010 (40 -combined small bowel and liver transplant, 2 -modified multivisceral transplant and 13 - isolated small bowel transplant).
Results: The table provides a summary of the complications.
|
Complication (number of episodes) |
< 3 months |
>3 months |
|
Infection (106) |
11 central venous line 8 wound 8 chest 7 enteritis 16 EBv viraemia |
27 viral enteritis 19 EBV viraemia 7 oesophageal candidiasis
|
|
Acute Rejection (60) |
7 severe |
6 severe |
|
Chronic rejection (5) |
0 |
5 with 3 requiring enterectomies |
|
Pancreatitis (5) |
3 following re transplant 1 primary transplant |
1 following treatment for GvHD |
|
Endocrine (6 insulin need) |
3 transient 1 long term |
2 transient following treatment for acute rejection |
|
Haematological (23) |
2 GvHD 4 autoimmune haemolysis |
3 GvHD 1 autoimmune haemolysis 14 neutropenia |
|
Neurological (8) |
3 seizures 1 fixed dilated pupils |
1 Cerebellar fungal lesion 1 Brain PTLD 3 posterior reversible encephalopathy 1 myalgic encephalomyelitis |
|
Renal (29) |
3 required CCVH:- -2 initially post transplant -1 following sepsis |
12 reduced creatinine clearance 14 hypertension |
|
Post transplant lymphoproliferative disease (10) |
1 |
9 |
Discussion: The incidence of viral gastroenteritis, hypertension, neutropenia and severe rejection late post transplant are complications in which the high incidence requires heightened monitoring and further investigation for therapeutic options.
Conclusion: An awareness of the potential complications and the timing for heightened vigilance will aid prompt treatment of complications in future transplants and improve long-term survival.
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