Florence Lacaille¹, Christophe Chardot², Olivier Goulet¹, Yann Revillon²

¹Pediatric Hepatogastroenterology-Nutrition, Hôpital Necker-Enfants malades, Paris, France, Metropolitan; ²Pediatric Surgery, Hôpital Necker-Enfants malades, Paris, France

Aim: To describe the mid- and long-term results of intestinal transplantation (Tx).

Patients: From 1994 until 2011, 89 children received 96 Tx: 54 isolated small bowel Tx (SBTx), 39 liver-small bowel Tx (L-SBTx, 2 with pancreas), 2 multivisceral Tx (from stomach to colon, pancreas and liver) including 1 with kidneys, 1 modified multivisceral Tx (without liver). Indications were: 30 short bowel syndroms, 29 congenital enteropathies, 28 motility disorders, 8 re-transplantations, et 2 other diagnosis. Follow-up is 4 months to 16.5 years (median 8 y).

Results: At 10 years, the actuarial survival rate is 52% for patients, same for L-SBTx and SBTx, including those in whom the SB graft has been removed, and 33% for grafts, 46% for L-SBTx, 9% for SBTx. Of 62 children (67 Tx) transplanted for more than 5 years, 21 (31%) have a functional graft, 2 after retransplantation : 11/19 and 4/11 L-SBTx for more than 10 y and 5-10 y respectively ; 1/13 and 5/19 SBTx for more than 10 y and 5-10 y. After SBTx, 27/53 grafts (51%) were removed, mostly in the 1st year, but 7 (13%) 2 to 9 y post-Tx, for acute or chronic rejection. The mortality rate is 35% (31/88) : 10 children died after SBTx, 21 after L-SBTx (2 after retransplantation, 3 after resection of the transplanted bowel), 25 in the year after Tx, five 2-10 y later of Tx-related complications, 1 in an accident.

Discussion: Early mortality is high for L-SBTx, but long-term graft survival is better than after SBTx. Intestinal transplantation is still a difficult procedure, and its indications are limited to the failures of long-term parenteral nutrition. Recent improvements have decreased the early mortality and graft removal. Improvements have to be made on the understanding and control of late graft losses and complications.