Combined Liver-Intestine Grafts Compared With Isolated Intestinal Transplantation in Children

Dopazo, Cristina; Gupte, Girish; Sharif, Khalid; Perera, M Thamara P R; Hartley, Jane; Muiesan, Paolo; Mayer, David; Bromley, Peter; Bennett, John M.; Kelly, D A; Mourik, Indra van; McKiernan, Patrick; Beath, S. V.; Mirza, Darius F.

doi:10.1097/tp.0b013e318265c508

Cited by 23 publications

(9 citation statements)

References 29 publications

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“…recently reported a prospective analysis of 51 children with intestinal failure who underwent transplantation, 39 of whom received combined liver and small bowel grafts. Mortality at 6 months after transplantation was 19%, all in the combined liver-small bowel transplantation group 49 . Similarly, Grant et al reported increased mortality one year after combined liver/small bowel transplantation than isolated small bowel (77% versus 60%, p <0.001) 50 .…”

Section: Discussionmentioning

confidence: 96%

The Natural History of Cirrhosis From Parenteral Nutrition-Associated Liver Disease After Resolution of Cholestasis With Parenteral Fish Oil Therapy

Nandivada¹,

Chang²,

Potemkin³

et al. 2015

Annals of Surgery

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Objective To determine the natural history of cirrhosis from parenteral nutrition-associated liver disease (PNALD) after resolution of cholestasis with fish oil (FO) therapy Background Historically, cirrhosis from PNALD resulted in end-stage liver disease (ESLD), often requiring transplantation for survival. With FO therapy, most children now experience resolution of cholestasis and rarely progress to ESLD. However, outcomes for cirrhosis after resolution of cholestasis are unknown and patients continue to be considered for liver/multivisceral transplantation. Methods Prospectively collected data was reviewed for children with cirrhosis due to PNALD who had resolution of cholestasis after treatment with FO from 2004 to 2012. Outcomes evaluated included need for liver/multivisceral transplantation, mortality, and the clinical progression of liver disease. Results Fifty-one patients with cirrhosis from PNALD were identified, with 76% demonstrating resolution of cholestasis after FO therapy. The mean direct bilirubin decreased from 6.4 ± 4 mg/dL to 0.2 ± 0.1 mg/dL (p <0.001) 12 months after resolution of cholestasis, with a mean time to resolution of 74 days. None of the patients required transplantation or died from ESLD. Pediatric End-Stage Liver Disease (PELD) scores decreased from 16 ± 4.6 to −1.2 ± 4.6, 12 months after resolution of cholestasis (p <0.001). In children who remained PN-dependent, the PELD score remained normal throughout the follow-up period. Conclusions Cirrhosis from PNALD may be stable rather than progressive once cholestasis resolves with FO therapy. Furthermore, these patients may not require transplantation and show no clinical evidence of liver disease progression, even when persistently PN-dependent.

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Section: Discussionmentioning

confidence: 96%

The Natural History of Cirrhosis From Parenteral Nutrition-Associated Liver Disease After Resolution of Cholestasis With Parenteral Fish Oil Therapy

Nandivada¹,

Chang²,

Potemkin³

et al. 2015

Annals of Surgery

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“…Surgical difficulties on wall closure and vascular complications as cause of early death or graft failure almost disappeared with the staged abdominal closure technique from the 2000s . Biliary complications were not totally prevented by the “en bloc” technique of L‐SBTx.…”

Section: Discussionmentioning

confidence: 99%

Twenty-eight years of intestinal transplantation in Paris: experience of the oldest European center

Lacaille¹,

Irtan²,

Dupic³

et al. 2017

Transpl Int

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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.

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“…The historic incidence of ACR (80%) has improved to 20-50% (6,(8)(9)(10)(11). The level of ACR has declined following the use of rATG (4,12). We used rATG and steroids for induction therapy and our ACR rate was 57%.…”

Section: Discussionmentioning

confidence: 96%

Pediatric small bowel transplantation: A single-center experience from Turkey

Tuğmen¹,

Baran²,

Sert³

et al. 2016

Turk J Gastroenterol

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Combined Liver-Intestine Grafts Compared With Isolated Intestinal Transplantation in Children

Abstract: Risk of mortality at 6 months after intestinal transplantation increased when the liver is included as combined graft. Strategies to reduce mortality such as refining selection for transplantation and early referral before the development of liver failure should be a priority.

Cited by 23 publications

References 29 publications

The Natural History of Cirrhosis From Parenteral Nutrition-Associated Liver Disease After Resolution of Cholestasis With Parenteral Fish Oil Therapy

The Natural History of Cirrhosis From Parenteral Nutrition-Associated Liver Disease After Resolution of Cholestasis With Parenteral Fish Oil Therapy

Twenty-eight years of intestinal transplantation in Paris: experience of the oldest European center

Pediatric small bowel transplantation: A single-center experience from Turkey

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