Lessons learned in pediatric small bowel and liver transplantation from living-related donors.
BACKGROUND
Children are the primary candidates for intestinal transplant with more than 70% requiring a combined liver-bowel transplant. We report our single-center experience with living donor intestinal transplantation (LDITx) and combined living donor intestinal and liver transplant (CLDILTx) in pediatric patients.


METHODS
Between October 2002 and June 2006, 13 living donor intestinal grafts were transplanted in 10 recipients. In five cases CLDILTx was performed. The intestinal grafts consisted of a 150-cm segment of ileum, whereas the liver transplant was completed using standard left lateral grafts.


RESULTS
No complications occurred in any donors. In CLDILTx recipients, the patient survival at 1 and 2 years was 100%, the liver graft survival 100%, and the bowel graft survival 80%; the patient who lost the initial intestinal graft was successfully retransplanted. In LDITx recipients, the patient and graft survival at 1 and 3 years were 60% and 50%, respectively. Two isolated LDITx recipients, both 6 months of age and low body weight (mean, 6 vs. 9 kg) died within 4 months posttransplant. One LDITx recipient developed chronic rejection 3.5 years after the original transplant and died after retransplant. All patients who are alive with functioning grafts are currently on full enteral feeding without need for any intravenous supplementation, except for a recipient of CLDILTx, currently on total parenteral nutrition for late fistula.


CONCLUSIONS
The early outcomes of intestinal transplantation from living donors are promising, particularly for candidates in need of CLDLITx. In this subgroup, the elimination of the high mortality on the cadaver waiting list (approximately 30%) represents a substantial advantage.
Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Antonio
A
Gangemi
Ivo G
IG
Tzvetanov
Elizabeth
E
Beatty
Jose
J
Oberholzer
Giuliano
G
Testa
Howard N
HN
Sankary
Bruce
B
Kaplan
Enrico
E
Benedetti
D002675:Child, Preschool; D005190:Family; D005260:Female; D006085:Graft Survival; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008297:Male; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D016896:Treatment Outcome