Factors affecting survival to intestinal transplantation in the very young pediatric patient.
BACKGROUND
Very young pediatric patients awaiting intestinal transplantation have a high mortality rate due to long waiting times, scarcity of appropriate size donor organs, and mortality due to sepsis and liver failure. To investigate specific risk factors impacting survival to intestinal transplantation, we performed a 4-year institutional retrospective study comparing children who received grafts by age 18 months with children 18 months or younger who died while on the waiting list.


METHODS
Twelve children comprised the transplanted group and had the underlying diagnoses: necrotizing enterocolitis, gastroschisis, Hirschsprung's disease, and omphalocele. Ten children comprised the deceased group and had the underlying diagnoses: intestinal atresia, necrotizing enterocolitis, gastroschisis, and midgut volvulus. Multiple risk factors were assessed in these groups.


RESULTS
No differences in residual small bowel length, presence of the colon, number of line infections, or number of central lines were found. The average body weight of the transplanted group trended higher, whereas the deceased group had more impairment of hepatic function. Intestinal atresia was the most common diagnosis in the deceased group while none of the transplanted group carried this diagnosis. Ileocecal valve was retained in 80% of the deceased group and in none of the transplanted group.


CONCLUSIONS
In children younger than 18 months, risk factors affecting survival to intestinal transplantation include small body size and advanced liver disease. A primary diagnosis of intestinal atresia and the presence of the ileocecal valve may confer additional risk to these very young children.
Mian
Sameera I
SI
Department of Pediatric Gastroenterology, Stanford University School of Medicine, Palo Alto, CA, USA.
Dutta
Sanjeev
S
Le
Brian
B
Esquivel
Carlos O
CO
Davis
Karen
K
Castillo
Ricardo O
RO
D001835:Body Weight; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000145:classification / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D008111:Liver Function Tests; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014850:Waiting Lists