TY - JOUR
T1 - Intestinal transplantation in children
T2 - A summary of clinical outcomes and prognostic factors in 108 patients from a single center
AU - Kato, Tomoaki
AU - Gaynor, Jeffrey J.
AU - Selvaggi, Genarro
AU - Mittal, Naveen
AU - Thompson, John
AU - McLaughlin, Gwenn E.
AU - Nishida, Seigo
AU - Moon, Jang
AU - Levi, David
AU - Madariaga, Juan
AU - Ruiz, Phillip
AU - Tzakis, Andreas
PY - 2005/1/1
Y1 - 2005/1/1
N2 - We performed 124 intestinal transplants on 108 children (median age, 1.5 years) since 1994. Initial graft types included isolated intestine (I) (n = 26), liver and intestine (LI) (n = 26), multivisceral (MV) (n = 50), and multivisceral without liver (MMV) (n = 6). Four groups were defined by type of induction therapy: none, OKT3, or cyclophosphamide (August 1994-December 1997, n = 25), early experience with daclizumab (January 1998-December 2000, n = 26), recent experience with daclizumab (January 2001-April 2004, n = 40), and Campath-1H (January 2001-April 2004, n = 17). Actuarial patient survival at 1 year for groups 1-4 was 44%±10%, 54%±10%, 83%±6%, and 41%±12%, respectively, with group 3 having the most favorable survival (P = 0.0004). Using Cox stepwise regression, the hazard rate of developing severe rejection was significantly higher in patients with transplant type I or LI (P = 0.0002), with no difference between these groups (P = 0.24) but a significantly higher rate for LI versus MV (P = 0.005). Three factors associated with improved patient survival were recipient of MV or MMV (P = 0.008), age at transplantation greater than 1 year (P = 0.01), and use of daclizumab (P = 0.0006). Cause-specific hazard analysis revealed a decreased rate of rejection-related mortality for recipients of MV or MMV (P = 0.0007), whereas age greater than 1 year indicated a lower rate of infection-related mortality (P = 0.0009). Pediatric intestinal transplantation provides an increasingly realistic chance of survival, particularly with the more recent use of daclizumab and multivisceral transplantation. A protective effect of multivisceral transplantation appears to exist with respect to the development of severe rejection.
AB - We performed 124 intestinal transplants on 108 children (median age, 1.5 years) since 1994. Initial graft types included isolated intestine (I) (n = 26), liver and intestine (LI) (n = 26), multivisceral (MV) (n = 50), and multivisceral without liver (MMV) (n = 6). Four groups were defined by type of induction therapy: none, OKT3, or cyclophosphamide (August 1994-December 1997, n = 25), early experience with daclizumab (January 1998-December 2000, n = 26), recent experience with daclizumab (January 2001-April 2004, n = 40), and Campath-1H (January 2001-April 2004, n = 17). Actuarial patient survival at 1 year for groups 1-4 was 44%±10%, 54%±10%, 83%±6%, and 41%±12%, respectively, with group 3 having the most favorable survival (P = 0.0004). Using Cox stepwise regression, the hazard rate of developing severe rejection was significantly higher in patients with transplant type I or LI (P = 0.0002), with no difference between these groups (P = 0.24) but a significantly higher rate for LI versus MV (P = 0.005). Three factors associated with improved patient survival were recipient of MV or MMV (P = 0.008), age at transplantation greater than 1 year (P = 0.01), and use of daclizumab (P = 0.0006). Cause-specific hazard analysis revealed a decreased rate of rejection-related mortality for recipients of MV or MMV (P = 0.0007), whereas age greater than 1 year indicated a lower rate of infection-related mortality (P = 0.0009). Pediatric intestinal transplantation provides an increasingly realistic chance of survival, particularly with the more recent use of daclizumab and multivisceral transplantation. A protective effect of multivisceral transplantation appears to exist with respect to the development of severe rejection.
KW - Intestinal transplantation
KW - children
KW - clinical outcomes
KW - prognostic factors
KW - single-center experience
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UR - http://www.scopus.com/inward/citedby.url?scp=19944373378&partnerID=8YFLogxK
U2 - 10.1016/j.gassur.2004.10.012
DO - 10.1016/j.gassur.2004.10.012
M3 - Article
C2 - 15623448
AN - SCOPUS:19944373378
SN - 1091-255X
VL - 9
SP - 75
EP - 89
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -