Surviving Pediatric Intestinal Transplantation

AK Balla et al. JPGN 2020; 71: 617-623. Factors Associated With 5- and 10-Year Survival After Intestinal Transplantation in Infants and Children

Methods: Retrospective chart review of 86 patients transplanted between 2003 and 2013

Key findings:

  • Intestinal graft survival was 71% and 65% after 5 and 10 years, respectively
  • Five-year graft survival was attained in 79% of patients with a history of anatomic intestinal failure (n=63) compared with 45% with functional intestinal failure (n=22) (P = 0.0055).
  • In their cohort, graft-versus-host and post-transplant lymphoproliferative disease were 11 times greater and 8 times greater in the functional compared with anatomic intestinal failure group. “Severe functional gastrointestinal diseases are more likely to be component of inherited multisystem disorders not fully correctable with ITx (intestinal transplantation) alone.”
  • Graft survival depends on avoidance of severe infectious and immunological complications including GVHD, whereas inclusion of a liver graft provides no obvious survival benefit

My take: In this cohorts, intestinal transplantation outcomes have improved for anatomic intestinal failure but not for functional intestinal failure. “Reduced success with functional intestinal failure may reflect inherently increased susceptibility to complications in this group.”