Beyond 10 years, with or without an intestinal graft: Present and future?

Abstract

Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m 2. Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.

Update on immunosuppressive strategies in intestinal transplantation

“…MMF has also been employed to reduce nephrotoxicity associated with long-term use of calcineurin inhibitors. When used in combination with tacrolimus and low-dose steroids, improved graft survival and lower rates of allorejection have been observed [20]. However, gastrointestinal (GI) adverse effects and cytopenias associated with its use have limited widespread adoption.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…Though this is a small study, it may represent the better management of intestinal failure over time, suggesting a prior overuse of intestinal transplant years ago in this population. 24…”

Glimmers of hope for intestinal transplantation

“…This edition of the AJT features a study from France titled “Beyond 10 Years, With or Without an Intestinal Graft: Present and Future?” with promising results for the field of intestinal transplantation (ITx) 1 . The authors studied children who received an ITx at their center between 1989 and 2007, analyzing 10‐year posttransplant outcomes in a cohort with and without a functional graft (26 and 9 patients, respectively).…”

“…with promising results for the field of intestinal transplantation (ITx). 1 The authors studied children who received an ITx at their center between 1989 and 2007, analyzing 10-year posttransplant outcomes in a cohort with and without a functional graft (26 and 9 patients, respectively). The overall 10-year patient and graft survival rates were 53% and 36%, respectively, and all patients in the group with a functional graft were weaned off parenteral nutrition and exhibited mostly normal physical growth and minimal abnormality in biopsies.…”