title: Limited surgical resection for graft salvage following recovery from complicated exfoliative rejection in pediatric intestinal recipients.
abstract: Complications of ER contribute significantly to morbidity and mortality following intestinal transplantation. The surgical management of three pediatric patients who experienced complications of late ER after composite LSB transplantation is described, highlighting the potential for allograft salvage after limited surgical resection. A retrospective case series was compiled. Data collected included time to ER from transplant, medical management of ER, complications, and surgical management of ER complications. All patients had undergone composite LSB transplantation between one and two yr of age. Time to ER after transplantation was 9.5-26.5 months. ER complications included ileal allograft stricture, intramural hematoma with perforation of jejunal allograft, and massive GI hemorrhage secondary to focal ulceration and pseudopolyp formation. With evidence of mucosal regeneration, all three patients underwent limited segmental allograft resection. Two patients continue to maintain satisfactory allograft function 39-44 months following operation. The third patient retained adequate allograft function until he developed PTLD, subsequently dying from disseminated Adenovirus infection 51 months after resection. Severe disruption of intestinal allograft integrity in ER can lend itself to medically refractory complications. Prompt recognition and surgical correction of complications can play a crucial role in allograft salvage and patient survival after ER.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Monique L
authors.initials: ML
authors.lastname: Goldschmidt
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kocoshis
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Tiao
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Alonso
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jaimie D
authors.initials: JD
authors.lastname: Nathan
mesh_terms: D002675:Child, Preschool; D003106:Colon / Q000601:surgery / Q000637:transplantation*; D005260:Female; D006084:Graft Rejection / Q000601:surgery*; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000601:surgery / Q000637:transplantation*; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: allograft; complications; graft rejection; liver/intestine transplant; pediatric transplantation