Expanded use of multivisceral transplantation for small children with concurrent liver and intestinal failure.
Fifty-five children with liver and intestinal failure have been transplanted at our center under daclizumab induction therapy since 1998. Of those, 19 received five multiviceral transplantation (MVT), 12 liver-intestine-pancreas transplants, and 2 noncomposite liver and intestine transplants (NCLIT) before 2001 (group 1). During this period, MVT was only used in children with gastric dysmotility. After 2001, we expanded the use of MVT. Therefore, 36 children in this period (group 2) received MVT except for two who received NCLIT. Median age was 1.08 in group 1 and 1.06 in group 2. Median recipient weight was 8.2 kg in group 1 and 7.5 kg in group 2. Six-month, 1-, and 2-year patient survivals were 54%, 37%, and 32% in group 1 and 94%, 91%, and 71% in group 2 (P = .00037). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019). A statistically significant difference was observed in freedom from rejection between the two groups with group 2 being favorable (P = .0019) Four died of rejection in group 1 (21%); none died of rejection in group 2. There have been two esophago-gastrostomy strictures (one in each group) and a serious reflux of this anastomosis (group 2). Strictures were treated with balloon dilatation, and the reflux was surgically corrected. In 24 recent cases, gastro-gastric anastomosis was used in MVT with no complications to date. No pancreatic rejection was seen. Small children tolerated MVT with improved survival rates and reduced rates of rejection. Use of MVT may be considered as an alternative to liver-intestine-pancreas transplant.
Kato
T
T
Divisions of Transplant, Pediatric Gastroenterology, Pediatric Critical Care Medicine, and Immunopathology, University of Miami, School of Medicine, 1801 NW 9th Avenue, Miami, FL 33136, USA. tkato@med.miami.edu
Selvaggi
G
G
Gaynor
J
J
Madariaga
J
J
McLaughlin
G
G
Thompson
J
J
Nishida
S
S
Moon
J
J
Levi
D
D
Ruiz
P
P
Tzakis
A
A
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D000077561:Daclizumab; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery*; D007422:Intestines / Q000601:surgery*; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D016035:Pancreas Transplantation; D016019:Survival Analysis; D017741:Survivors; D014184:Transplantation, Homologous / Q000276:immunology / Q000401:mortality; D014781:Viscera / Q000637:transplantation*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000077561:Daclizumab