title: Long-term outcomes of living-related small intestinal transplantation in children: A single-center experience.
abstract: Pediatric patients with irreversible intestinal failure present a significant challenge to meet the nutritional needs that promote growth. From 2002 to 2013, 13 living-related small intestinal transplantations were performed in 10 children, with a median age of 18 months. Grafts included isolated living-related intestinal transplantation (n=7), and living-related liver and small intestine (n=6). The immunosuppression protocol consisted of induction with thymoglobulin and maintenance therapy with tacrolimus and steroids. Seven of 10 children are currently alive with a functioning graft and good quality of life. Six of the seven children who are alive have a follow-up longer than 10 years. The average time to initiation of oral diet was 32 days (range, 13-202 days). The median day for ileostomy takedown was 77 (range, 18-224 days). Seven children are on an oral diet, and one of them is on supplements at night through a g-tube. We observed an improvement in growth during the first 3 years post-transplant and progressive weight gain throughout the first year post-transplantation. Growth catch-up and weight gain plateaued after these time periods. We concluded that living donor intestinal transplantation potentially offers a feasible, alternative strategy for long-term treatment of irreversible intestinal failure in children.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Garcia Aroz
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: Ivo
authors.initials: I
authors.lastname: Tzvetanov
authors.affiliation: Department of Pharmacy, University of Illinois, Chicago, IL, USA.
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Hetterman
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: Hoonbae
authors.initials: H
authors.lastname: Jeon
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.affiliation: Division of Transplantation, Department of Surgery, Baylor University, Houston, TX, USA.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Testa
authors.affiliation: Division of Nephrology, Department of Pediatrics, University of Illinois, Chicago, IL, USA.
authors.forename: Eunice
authors.initials: E
authors.lastname: John
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000637:transplantation*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: growth; intestinal transplantation; living donor; pediatric transplantation; quality of life; survival