Outcomes in children after intestinal transplant

Abstract

Objective: The survival rates after pediatric intestinal transplant according to underlying disease are unknown. The objective of our study was to describe the population of pediatric patients receiving an intestinal transplant and to evaluate survival according to specific disease condition.

Patients: Pediatric patients (< or =21 years of age) with intestinal failure meeting criteria for intestinal transplant were included in the study.

Methods: A retrospective review of the United Network for Organ Sharing intestinal transplant database (January 1, 1991, to May 16, 2008), including all pediatric transplant centers participating in the United Network for Organ Sharing, was conducted. The main outcome measures were survival and mortality.

Results: Eight hundred fifty-two children received an intestinal transplant (54% male). Median age and weight at the time of transplant were 1 year (interquartile rage: 1-5) and 10.7 kg (interquartile rage: 7.8-21.7). Sixty-nine percent of patients also received a simultaneous liver transplant. The most common diagnoses among patients who received a transplant were gastroschisis (24%), necrotizing enterocolitis (15%), volvulus (14%), other causes of short-gut syndrome (19%), functional bowel syndrome (16%), and Hirschsprung disease (7%). The Kaplan-Meier curves demonstrated variation in patient survival according to diagnosis. Cox regression analysis confirmed a survival difference according to diagnosis (P < .001) and demonstrated a survival advantage for those patients listed with a diagnosis of volvulus (P < .01) compared with the reference gastroschisis. After adjusting for gender, recipient weight, and concomitant liver transplant, children with volvulus had a lower hazard ratio for survival and a lower risk of mortality.

Conclusions: Survival after intestinal transplant was associated with the underlying disease state. The explanation for these findings requires additional investigation into the differences in characteristics of the population of children with intestinal failure.

FIGURE 1

Study subject selection outline from UNOS database (≤21 years of age at listing).

FIGURE 2

Diagnoses of children who received a transplant (at listing) (N = 810).

FIGURE 3

Overall survival rates after transplant (not all children had available follow-up time).

FIGURE 4

Overall survival rates after transplant stratified according to concomitant liver transplant among the 6 most common diagnostic conditions.

FIGURE 5

Intestinal transplant recipient survival rates according to diagnosis (not all children have available follow-up time).

FIGURE 6

Intestinal transplant recipient survival rates according to 6 most common diagnoses, with 95% CIs.

FIGURE 7

Intestinal transplant recipient survival rates, with 95% CIs: volvulus and gastroschisis.