title: Impact of Intestinal Rehabilitation Program and Its Innovative Therapies on the Outcome of Intestinal Transplant Candidates.
abstract: OBJECTIVE
  The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list.
  
  
  METHODS
  A retrospective cohort study of children assessed for IT (n = 84) during a 10-year period. Comparisons were made among the following 3 time periods: before the establishment of our center's IRP (1999-2002; n = 33), early IRP (2003-2005; n = 18), and late IRP (2006-2009; n = 33). The following endpoints were used: patient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study.
  
  
  RESULTS
  The late-IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005).
  
  
  CONCLUSIONS
  Treatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
authors.affiliation: *Division of Gastroenterology, Hepatology and Nutrition †Transplant Centre ‡Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.forename: Jenny Y
authors.initials: JY
authors.lastname: Wang
authors.forename: Nicole T
authors.initials: NT
authors.lastname: de Silva
authors.forename: Karolina M
authors.initials: KM
authors.lastname: Burghardt
authors.forename: Maria
authors.initials: M
authors.lastname: DeAngelis
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Ng
authors.forename: Nicola
authors.initials: N
authors.lastname: Jones
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery / Q000628:therapy*; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D008297:Male; D016377:Organ Transplantation; D012189:Retrospective Studies; D035703:Therapies, Investigational; D014850:Waiting Lists