title: Pediatric intestinal retransplantation: techniques, management, and outcomes.
abstract: BACKGROUND
  Intestinal retransplantation (Re-ITx) has historically been associated with high morbidity and mortality.
  
  
  METHODS
  The outcomes of all children receiving Re-ITx between 1990 and 2007 at our center were reviewed.
  
  
  RESULTS
  One hundred seventy-two children received primary intestinal grafts. Fourteen children (8.1%) were retransplanted with 15 grafts. Causes of graft failure were acute cellular rejection (ACR, n=4), liver failure (n=2), chronic rejection (n=3), posttransplant lymphoproliferative disorder (n=1), graft dysmotility or dysfunction (n=3), ACR with severe infection (n=1), and arterial graft aneurysm (n=1). Initial transplants were isolated bowel in nine, liver-bowel in five, and one multivisceral. The mean time of initial graft survival was 34.2 months. Re-ITx was with isolated bowel in two, liver-bowel in four, and multivisceral in nine (four with kidney). Initial immunosuppression was Tac-Pred based in nine and rabbit antithymocyte globulin-Tac based in six cases. Re-ITx was carried out under Tac-Pred in six, rabbit antithymocyte globulin-Tac in eight, and alemtuzumab monoclonal anti-CD52 antibody in one. Ten (71.4%) patients are alive with functioning grafts at a mean current follow-up time of 55.9 months. Four patients died from posttransplant lymphoproliferative disorder, severe ACR, fungal sepsis, and bleeding from pseudoaneurysm, respectively, at a mean time of 5.7 months post-Re-ITx. All surviving patients weaned-off total parenteral nutrition at a median time of 32 days and 90% are off intravenous fluids.
  
  
  CONCLUSIONS
  Improved long-term survival and outcome in pediatric Re-ITx may be attributed to improvements in initial immunosuppression protocols, technical modifications, proper timing, and improved infectious disease monitoring. Careful patient selection and posttransplant management are essential for successful long-term outcome.
authors.affiliation: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. george.mazariegos@chp.edu
authors.forename: George V
authors.initials: GV
authors.lastname: Mazariegos
authors.forename: Kyle
authors.initials: K
authors.lastname: Soltys
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bond
authors.forename: Alin
authors.initials: A
authors.lastname: Girnita
authors.forename: Zurab
authors.initials: Z
authors.lastname: Machaidze
authors.forename: Ronald
authors.initials: R
authors.lastname: Jaffe
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Dolly
authors.initials: D
authors.lastname: Martin
authors.forename: Adriana
authors.initials: A
authors.lastname: Zeevi
authors.forename: Robert
authors.initials: R
authors.lastname: Squires
authors.forename: Graciela
authors.initials: G
authors.lastname: Perez
authors.forename: Kareem
authors.initials: K
authors.lastname: Abu-Elmagd
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sindhi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D011183:Postoperative Complications / Q000145:classification / Q000276:immunology; D012086:Reoperation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult