Elsevier

Transplantation Proceedings

Volume 38, Issue 6, July–August 2006, Pages 1711-1712
Transplantation Proceedings

Outcome
Analysis of Rejection Episodes in Over 100 Pediatric Intestinal Transplant Recipients

https://doi.org/10.1016/j.transproceed.2006.05.061Get rights and content

Abstract

Rejection after intestinal transplant is a significant source of morbidity and mortality. We analyzed number of rejections, severity, and duration of episodes in pediatric recipients of intestinal transplants. One hundred eighteen intestinal transplants were performed: intestine (n = 27), liver-intestine (n = 27), modified multivisceral (n = 7), and multivisceral (n = 57). A total of 186 rejections were classified: mild (n = 89), moderate (n = 70), severe (n = 27). Duration of episodes doubled for each increasing step in severity. Treatment of mild rejection was with steroids, moderate rejection was treated with OKT3, severe rejection required OKT3 and organ removal. Most rejections occurred during the first month posttransplant, with the incidence of all rejections declining after 6 months posttransplant. Intestine and liver-intestine recipients had significantly higher probability of developing severe rejections, as compared to MVT. In summary, recipients of MVT seemed to be protected from rejection as compared to intestine or liver-intestine 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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