title: Twenty-eight years of intestinal transplantation in Paris: experience of the oldest European center.
abstract: Our aim was to describe our achievements in pediatric intestinal transplantation (ITx) and define areas for improvement. After a period (1987-1990) of nine isolated small bowel transplants (SBTx) where only one patient survived with her graft, 110 ITx were performed on 101 children from 1994 to 2014: 60 SBTx, 45 liver-small bowel, four multivisceral (three with kidneys), and one modified multivisceral. Indications were short bowel syndrome (36), motility disorders (30), congenital enteropathies (34), and others (1). Induction treatment was introduced in 2000. Patient/graft survival with a liver-containing graft or SBTx was, respectively, 60/41% and 46/11% at 18 years. Recently, graft survival at 5/10 years was 44% and 31% for liver-containing graft and 57% and 44% for SBTx. Late graft loss occurred in 13 patients, and 7 of 10 retransplanted patients died. The main causes of death and graft loss were sepsis and rejection. Among the 55 currently living patients, 21 had a liver-containing graft, 19 a SBTx (17 after induction), and 15 were on parenteral nutrition. ITx remains a difficult procedure, and retransplantation even more so. Over the long term, graft loss was due to rejection, over-immunosuppression was not a significant problem. Multicenter studies on immunosuppression and microbiota are urgently needed.
authors.affiliation: Pediatric Gastroenterology-Hepatology-Nutrition, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Lacaille
authors.affiliation: Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Sabine
authors.identifier: http://orcid.org/0000-0001-5596-9570
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Pediatric Intensive Care, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Dupic
authors.affiliation: Pediatric Gastroenterology-Hepatology-Nutrition, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Talbotec
authors.affiliation: Pediatric Intensive Care, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lesage
authors.affiliation: Pediatric Gastroenterology-Hepatology-Nutrition, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Virinie
authors.initials: V
authors.lastname: Colomb
authors.affiliation: Anesthesiology, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Nadège
authors.initials: N
authors.lastname: Salvi
authors.affiliation: Pediatric Intensive Care, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Moulin
authors.affiliation: Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Sauvat
authors.affiliation: Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Aigrain
authors.affiliation: Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Revillon
authors.affiliation: Pediatric Gastroenterology-Hepatology-Nutrition, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.affiliation: Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Chardot
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D006085:Graft Survival; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D010297:Paris / Q000453:epidemiology; D010372:Pediatrics / Q000266:history; D012086:Reoperation; D014180:Transplantation / Q000009:adverse effects / Q000266:history* / Q000401:mortality; D014181:Transplantation Immunology; D055815:Young Adult
keywords: graft loss; intestinal transplantation; multivisceral transplantation; survival