Open AccessTwenty‐eight years of intestinal transplantation in Paris: experience of the oldest European center
Author(s) -
Lacaille Florence,
Irtan Sabine,
Dupic Laurent,
Talbotec Cécile,
Lesage Fabrice,
Colomb Virinie,
Salvi Nadège,
Moulin Florence,
Sauvat Frédérique,
Aigrain Yves,
Revillon Yann,
Goulet Olivier,
Chardot Christophe
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12894
Subject(s) - medicine , immunosuppression , parenteral nutrition , sepsis , short bowel syndrome , transplantation , surgery , liver transplantation , gastroenterology , single center
Summary Our aim was to describe our achievements in pediatric intestinal transplantation ( IT x) and define areas for improvement. After a period (1987–1990) of nine isolated small bowel transplants ( SBT x) where only one patient survived with her graft, 110 IT x were performed on 101 children from 1994 to 2014: 60 SBT x, 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 SBT x 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 SBT x. 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 SBT x (17 after induction), and 15 were on parenteral nutrition. IT x 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.