OutcomeAnalysis of Rejection Episodes in Over 100 Pediatric Intestinal Transplant Recipients
Section snippets
Patients and methods
The surgical techniques for these transplants have been previously described.2 We divided the type of intestinal grafts into four categories: isolated intestine (I), liver-intestine (LI), modified multivisceral (MMV), and multivisceral (MVT). Baseline immunosuppression was with steroids and tacrolimus, induction was with daclizumab (Zenapax, Roche Pharmaceuticals, Nutley, NJ) for 6 months or alemtuzumab (Campath IH, Berlex Laboratories, Montville, NJ). Graft monitoring was performed with serial
Results
A total of 118 (I n = 27; LI n = 27; MMV n = 7; MVT n = 57) primary transplants were performed (65 males, 53 females); age was 160 days to 17.4 years; follow-up was 32 days to 10.4 years. Most common diagnoses were gastroschisis (27%), necrotizing enterocolitis (19%), and intestinal atresia (14%). A total of 186 rejections occurred: 89 mild (48%), 70 moderate (38%), 27 severe (14%). Thirty percent of patients had no rejection episodes, 58% had one to three, and 12% more than three. The first
Discussion
Our analysis shows that acute episodes of rejection occur early posttransplant, mostly within the first 6 months, and then decline rapidly with very few episodes observed past 2 years after transplant. Length of time of rejection roughly doubles for each step of increasing severity, so that a mild rejection usually lasts 1 week, a moderate rejection lasts 2 weeks, while a severe rejection lasts for about 1 month. Moderate and severe rejections can be treated with steroids, but more often
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Cited by (7)
Immunologic aspects and rejection in solid organ versus reconstructive transplantation
2010, Transplantation ProceedingsCitation Excerpt :Analyses have also revealed that the ileum and the duodenum are the most involved areas during acute rejection episodes.67 Interestingly, an increased incidence of rejection has been observed in recipients of isolated intestinal or liver-intestine compared with multivisceral grafts.68,69 Lung allografts, which also contain a large mucosal surface, are known to be highly immunogenic, similarly to the intestine and skin.
Outcomes in children with intestinal failure following listing for intestinal transplant
2010, Journal of Pediatric SurgeryCitation Excerpt :Several studies have examined the relationship between a liver or multivsiceral transplant along with the intestinal transplant and outcomes. Although some have demonstrated the feasibility of these procedures without additional morbidity or mortality [13,14], others contend that the need for a liver in addition to an intestine transplant may lead to the higher waitlist mortality demonstrated among this population [12]. There are several limitations to our study.
Small intestine
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2008, Revista da Associacao Medica Brasileira