Late graft loss and long-term outcome after isolated intestinal transplantation in children.
OBJECTIVE
The aim of this study was to determine causes of late graft loss and long-term outcome after isolated intestinal transplantation in children at a single center.


METHODS
All children who underwent primary isolated intestinal transplantation at our center with a minimum follow-up of 1 year were the subject of this retrospective study.


RESULTS
Twenty-eight children underwent primary isolated intestinal transplantation. Median graft survival was 705 days (range, 0 to 2,630 days) and median patient survival was 1,006 days (range, 0 to 2,630 days). There were 6 deaths and 15 graft losses (including the 6 nonsurvivors). Seven of the losses occurred 6 or more months after transplant. Of these, 2 losses occurred because of death of the recipients of sepsis; both recipients had functioning grafts. The 5 remaining late graft losses occurred because of acute rejection in 2 patients, chronic rejection in 2 (1 with concomitant acute rejection) and a diffuse stricturing process without the histologic hallmarks of chronic rejection in the fifth. All late survivors with intact grafts are off total parenteral nutrition (TPN).


CONCLUSIONS
Late graft loss remains a concern in a small percentage of patients after isolated intestinal transplantation. Nutritional autonomy from TPN is possible in the majority of these children after transplantation.
Iyer
K R
KR
Omaha, Nebraska, USA.
Srinath
C
C
Horslen
S
S
Fox
I J
IJ
Shaw
B W
BW
Sudan
D L
DL
Langnas
A N
AN
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D007410:Intestinal Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery; D007421:Intestine, Small / Q000637:transplantation; D007422:Intestines / Q000637:transplantation*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus