title: Study of the impact of liver transplantation on the outcome of intestinal grafts in children.
abstract: BACKGROUND
  Successful small bowel transplantation remains a challenge due to the septic and immune content of the gut. The possible beneficial role of the liver was assessed in pediatric recipients of isolated intestinal and liver intestinal combined transplantation, receiving the same immunosuppressive therapy.
  
  
  METHODS
  Fifteen children who underwent small bowel transplantation (seven SbTx) or combined liver-small bowel transplantation (eight LSbTx) at a single center between 1994 and 1998 were retrospectively reviewed and compared with fifteen controls (eight normal and seven appendicitis as inflammatory control). Transplant and patient survival, acute rejection episodes were analyzed and compared. Epithelial apoptotic body counts (ABC) and NF-kB (p65), Caspase-3 and Bax intestinal immunostaining from days 0 to 20 after transplantation were assessed.
  
  
  RESULTS
  Graft and patient survivals at 5 years were respectively 75% and 75% in LSbTx; 43% and 57% in SbTx (NS). Histological analysis showed higher ABC in LSbTx intestinal mucosa (P = 0.05 on day 5, P < 0.01 thereafter). Immunostaining of biopsies on day 0 after reperfusion showed different expression of NF-kB, Caspase-3 and Bax on endothelial (P < 0.05 for NF-kB and Bax), mononuclear (P < 0.05 for Bax) and epithelial cells in LSbTx and SbTx.
  
  
  CONCLUSIONS
  Our results suggest a protective role of the liver toward intestinal transplantation even in absence of significative difference, probably due to the small number of children. Early changes in NF-kB immunostaining in the biopsies sampled on day 0, pointed to a possible beneficial effect of the liver in the very early phase following transplantation, perhaps through the differential control of ischemia-reperfusion.
authors.affiliation: Pediatrics Department, Saint-Vincent-de-Paul Hospital, Necker-Enfants Malades Hospital, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Jugie
authors.forename: Danielle
authors.initials: D
authors.lastname: Canioni
authors.forename: Christine
authors.initials: C
authors.lastname: Le Bihan
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
authors.forename: Yann
authors.initials: Y
authors.lastname: Revillon
authors.forename: Dominique
authors.initials: D
authors.lastname: Jan
authors.forename: Florence
authors.initials: F
authors.lastname: Lacaille
authors.forename: Nadine
authors.initials: N
authors.lastname: Cerf-Bensussan
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.forename: Nicole
authors.initials: N
authors.lastname: Brousse
authors.forename: Diane
authors.initials: D
authors.lastname: Damotte
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D016559:Tacrolimus