Details

Autor(en) / Beteiligte

• Courbage, Sophie
• Canioni, Danielle
• Talbotec, Cécile
• Lambe, Cécile
• Chardot, Christophe
• Rabant, Marion
• Galmiche, Louise
• Corcos, Olivier
• Goulet, Olivier
• Joly, Francisca
• Lacaille, Florence

Titel

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

Ist Teil von

• American journal of transplantation, 2020-10, Vol.20 (10), p.2802-2812

Ort / Verlag

United States: Elsevier Limited

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• 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 m2. 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. The authors investigate if intestinal transplantation can support, in the long‐term, satisfactory and stable digestive function. See Kroemer's editorial on page 2642.