Study of the impact of liver transplantation on the outcome of intestinal grafts in children.
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.
Jugie
Myriam
M
Pediatrics Department, Saint-Vincent-de-Paul Hospital, Necker-Enfants Malades Hospital, Paris, France.
Canioni
Danielle
D
Le Bihan
Christine
C
Sarnacki
Sabine
S
Revillon
Yann
Y
Jan
Dominique
D
Lacaille
Florence
F
Cerf-Bensussan
Nadine
N
Goulet
Olivier
O
Brousse
Nicole
N
Damotte
Diane
D
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
D015415:Biomarkers; D007166:Immunosuppressive Agents; D016559:Tacrolimus