Early referral is essential for successful pediatric small bowel transplantation: The Canadian experience.
OBJECTIVE
The mortality rate for pediatric patients on the waiting list for transplantation has a major impact on the overall effectiveness of pediatric small bowel transplantation. This review was undertaken to determine the fate of Canadian children assessed for small bowel transplant and the outcome of those who undergo transplant in the tacrolimus era.


METHODS
The authors reviewed retrospectively all of the pediatric small bowel patients listed since 1988 through the Canadian Organ Replacement Register and all the children referred to our program in its first year. All children who received a small bowel transplant between January 1993 and December 1999 also were reviewed.


RESULTS
The mortality rate for pediatric patients on the small bowel transplant list was 53% after an average of 105 days on the list compared with 212 days for those who underwent transplant. Patients who died while on the list were younger and had signs of advanced liver disease at the time of listing. Thirteen Canadian children have received a small bowel transplant with an overall 1-year patient and graft survival rate of 61% and 53%, respectively. Survivors are all independent from total parenteral nutrition.


CONCLUSIONS
Many Canadian children miss their opportunity for a successful small bowel transplant because of late referrals and a shortage of donor organs.
Fecteau
A
A
Department of Pediatric Surgery, The Hospital for Sick Children of Toronto, and the Pediatric Transplant Program, Children's Hospital of Western Ontario, London, Ontario, Canada.
Atkinson
P
P
Grant
D
D
D002648:Child; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007421:Intestine, Small / Q000637:transplantation*; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D010289:Parenteral Nutrition, Total; D018579:Patient Selection; D012017:Referral and Consultation / Q000458:organization & administration*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014850:Waiting Lists