2011 - ISBTS 2011 Symposium

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Oral Communications 16: Long Term Outcomes

21.322 - Small bowel transplant programme - 1993-2011; strategies for improvement in medium and long term survival

Presenter: Girish, Gupte, Birmingham, United Kingdom
Authors: Girish Gupte1, Khalid Sharif1, Paolo Muiesan1, Susan Beath1, Deirdre Kelly1, Carla Lloyd1, Jane Hartley1, Darius Mirza1

Small bowel transplant programme - 1993-2011; strategies for improvement in medium and long term survival

Girish Gupte, Khalid Sharif, Paolo Muiesan, Susan Beath, Deirdre Kelly, Carla Lloyd, Jane Hartley, Darius Mirza

Liver unit (including small bowel transplantation), Birmingham Children's Hospital, Birmingham, United Kingdom

Background and Aim: Short-term survival following intestinal transplantation (ITx) has improved worldwide, however there has been a lag in improvement of medium and long-term survival. To report on our experience of ITx since inception of the programme and to develop strategies for improvement of long- term outcomes.

Methods: Retrospective review of the Liver Unit database to identify deaths > 6 months after transplantation.

Results: 350 children assessed for ITx and 78 transplants were done in 72 patients. Fifty-three liver inclusion graft (LITx)[4 multivisceral, 19 liver-bowel, 30 reduced] and 25 intestinal (IITx) grafts alone [4 modified MV, 21 isolated bowel (IB)]. For LITx and IITx alone respectively median age (2.2 yrs, 4.5 yrs) ,waiting time (2.6 months, 7.9 months, donor:recipient ratio (2.6:1,2.2:1). Abdominal prosthesis was required in 25/53 of LITx and 3/25 of IITx. 24/53 died after LITx and 6/25 died after IITx. 11/24 children with LITx and 5/6 children with IITx died after 6 months. The common casues of death in LITx ( 2 PTLD, 4 chronic rejection, 4 sepsis, 1 GVHD) and IITx (2 chronic rejection, 1 PTLD, 1 GVHD and 1 sudden death unrelated to ITx). The patient survival is as demonstrated in Figure 1. Six retransplants were done in 5 patients ( 2 LITx- 0% survival, 2 IITx- 100% survival and one child had IITx- graft failure- re-Tx done with LITx- died). Two children with high panel reactive antibodies have undergone ITx and are doing well with funtioning grafts without any significant rise in donor-specific antibodies. The majority of causes of death after 6 months is related to chronic rejection (3 cases related to non-compliance) and oppportunistic infections.

Conclusion: Strategies to optimise immuosuppression, support families, children with medication compliance and monitor for opportunistic infections may contribute to improved medium- long-term survival in ITx.

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