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Ueno T, Wada M, Ogawa E, Matsuura T, Yamada Y, Sakamoto S, Okuyama H. Present state of intestinal transplantation in Japan. Pediatr Surg Int 2023; 39:276. [PMID: 37755555 PMCID: PMC10533569 DOI: 10.1007/s00383-023-05552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Intestinal transplantation (ITx) is the ultimate treatment for intestinal failure (IF). In Japan, most cases of IF are a result of pediatric disease, including secondary or congenital intestinal disease or allied disorders of Hirschsprung's disease. Here, we report the results of the Japanese ITx registry. METHODS A web-based survey form was completed. We investigated the number, age, sex, indication, surgical procedure, immunosuppressants, postoperative course, and the effects of transplantation in patients who underwent cadaveric or living-donor ITx. RESULTS By the end of 2022, 42 cases of ITx have been performed in 38 patients in Japan. The donor sources included cadavers (29 cases) and living donors (13 cases). The surgical method was isolated ITx (N = 40) and combined liver and ITx (n = 2). Survival rates were 92%, 73%, and 59% at 1 year, 5 years, and 10 years, respectively. Ninety percent of patients completely discontinued parenteral nutrition. Approximately 80% of the patients had a performance status of 1 or less, indicating that the QOL of patients after ITx was extremely good. CONCLUSION The results of ITx are acceptable to treat IF patients and the QOL after transplantation is also good.
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Affiliation(s)
- Takehisa Ueno
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Motoshi Wada
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho Aoba-ku, Sendai-shi, Miyagi-ken, Japan
| | - Eri Ogawa
- Department of Surgery, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery/Transplant Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Lacaille F, Irtan S, Dupic L, Talbotec C, Lesage F, Colomb V, Salvi N, Moulin F, Sauvat F, Aigrain Y, Revillon Y, Goulet O, Chardot C. Twenty-eight years of intestinal transplantation in Paris: experience of the oldest European center. Transpl Int 2017; 30:178-186. [DOI: 10.1111/tri.12894] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/31/2016] [Accepted: 11/20/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition; Necker-Enfants malades Hospital; Paris France
| | - Sabine Irtan
- Pediatric Surgery; Necker-Enfants malades Hospital; Paris France
| | - Laurent Dupic
- Pediatric Intensive Care; Necker-Enfants malades Hospital; Paris France
| | - Cécile Talbotec
- Pediatric Gastroenterology-Hepatology-Nutrition; Necker-Enfants malades Hospital; Paris France
| | - Fabrice Lesage
- Pediatric Intensive Care; Necker-Enfants malades Hospital; Paris France
| | - Virinie Colomb
- Pediatric Gastroenterology-Hepatology-Nutrition; Necker-Enfants malades Hospital; Paris France
| | - Nadège Salvi
- Anesthesiology; Necker-Enfants malades Hospital; Paris France
| | - Florence Moulin
- Pediatric Intensive Care; Necker-Enfants malades Hospital; Paris France
| | | | - Yves Aigrain
- Pediatric Surgery; Necker-Enfants malades Hospital; Paris France
| | - Yann Revillon
- Pediatric Surgery; Necker-Enfants malades Hospital; Paris France
| | - Olivier Goulet
- Pediatric Gastroenterology-Hepatology-Nutrition; Necker-Enfants malades Hospital; Paris France
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Demir Z, Frange P, Lacaille F. Vaccinations, response, and controls before and after intestinal transplantation in children. Pediatr Transplant 2016; 20:449-55. [PMID: 26847771 DOI: 10.1111/petr.12669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/25/2022]
Abstract
Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine-preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP-IPV and HBV. After transplantation, the negative antibodies against vaccine-preventable diseases were mostly related to an antirejection therapy: for DTaP-IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post-transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine-preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.
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Affiliation(s)
- Z Demir
- Pediatric Hepato-Gastro-Enterology-Nutrition Unit, Necker-Enfants Malades Hospital, Paris, France
| | - P Frange
- Microbiology Department, Necker-Enfants Malades Hospital, Paris, France.,Pediatric Immunology and Hematology Unit, Necker Hospital, Paris, France.,EA 7327, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - F Lacaille
- Pediatric Hepato-Gastro-Enterology-Nutrition Unit, Necker-Enfants Malades Hospital, Paris, France
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Liver inclusion improves outcomes of intestinal retransplantation in adults. [Corrected]. Transplantation 2015; 99:1265-72. [PMID: 25427167 DOI: 10.1097/tp.0000000000000488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Retransplantation is a viable treatment option for patients with primary intestinal graft loss. METHODS We analyzed outcomes of retransplantations (n = 23) in adults from May 2000 to May 2010 at our center and compared patients who received liver-free retransplantations (n = 13) with those who received liver-inclusive retransplantations (n = 10). RESULTS The overall survival rates at 1, 3, and 5 years in retransplantations were 90.9%, 67.1%, and 59.7% (patient) and 82.2%, 58.6%, and 51.3% (graft), respectively, which were similar to the rates in primary transplants. The patient survival rates at 1, 3, and 5 years were 91.7%, 55.6%, and 41.7%, respectively, in liver-free retransplantations, as compared to rates of 90.0%, 80.0%, and 80.0% in liver-inclusive retransplantations. The graft survival rates at 1, 3, and 5 years in liver-free retransplantations were 76.2%, 40.6%, and 27.1%, respectively, which were significantly worse than those in liver-inclusive retransplantations (P = 0.03). Within an average follow-up of 32.3 months, 8 of 13 (61.5%) of liver-free retransplantations underwent enterectomy because of severe acute cellular rejection (n = 3) or chronic rejection (n = 5). Six of 13 (46.2%) recipients succumbed to rejection-related complications. Compared to liver-free retransplantations, the rate and severity of acute rejection were markedly de creased in liver-inclusive retransplantations, and no chronic rejection was seen. Within an average follow-up of 44.5 months, two of 10 (20%) died due to graft-versus-host disease and infection, respectively. CONCLUSION A liver-inclusive retransplantation offers a better long-term patient and graft survival, suggesting that including the liver as part of an intestinal graft should be considered in adult recipients when retransplantation is necessary.
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Grant D, Abu-Elmagd K, Mazariegos G, Vianna R, Langnas A, Mangus R, Farmer DG, Lacaille F, Iyer K, Fishbein T. Intestinal transplant registry report: global activity and trends. Am J Transplant 2015; 15:210-9. [PMID: 25438622 DOI: 10.1111/ajt.12979] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/16/2014] [Accepted: 08/12/2014] [Indexed: 01/25/2023]
Abstract
The Registry has gathered information on intestine transplantation (IT) since 1985. During this time, individual centers have reported progress but small case volumes potentially limit the generalizability of this information. The present study was undertaken to examine recent global IT activity. Activity was assessed with descriptive statistics, Kaplan-Meier survival curves and a multiple variable analysis. Eighty-two programs reported 2887 transplants in 2699 patients. Regional practices and outcomes are now similar worldwide. Current actuarial patient survival rates are 76%, 56% and 43% at 1, 5 and 10 years, respectively. Rates of graft loss beyond 1 year have not improved. Grafts that included a colon segment had better function. Waiting at home for IT, the use of induction immune-suppression therapy, inclusion of a liver component and maintenance therapy with rapamycin were associated with better graft survival. Outcomes of IT have modestly improved over the past decade. Case volumes have recently declined. Identifying the root reasons for late graft loss is difficult due to the low case volumes at most centers. The high participation rate in the Registry provides unique opportunities to study these issues.
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Affiliation(s)
- D Grant
- Department of Surgery, University Health Network, Toronto, Canada
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Nassif S, Kaufman S, Vahdat S, Yazigi N, Kallakury B, Island E, Ozdemirli M. Clinicopathologic features of post-transplant lymphoproliferative disorders arising after pediatric small bowel transplant. Pediatr Transplant 2013; 17:765-73. [PMID: 24118781 DOI: 10.1111/petr.12150] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 01/31/2023]
Abstract
Few studies examined the clinicopathologic features of PTLD arising in pediatric SBT patients. Particularly, the association between ATG and PTLD in this population has not been described. Retrospective review of 81 pediatric patient charts with SBT--isolated or in combination with other organs--showed a PTLD incidence of 11%, occurring more frequently in females (median age of four yr) and with clinically advanced disease. Monomorphic PTLD was the most common histological subtype. There was a significant difference in the use of ATG between patients who developed PTLD and those who did not (p < 0.01); a similar difference was seen with the use of sirolimus (p < 0.001). These results suggested a link between the combination of ATG and sirolimus and development of more clinically and histologically advanced PTLD; however, the risk of ATG by itself was not clear. EBV viral loads were higher in patients with PTLD, and median time between detection of EBV to PTLD diagnosis was three months. However, viral loads at the time of PTLD diagnosis were most often lower than at EBV detection, thereby raising questions on the correlation between decreasing viral genomes and risk of PTLD.
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Affiliation(s)
- S Nassif
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
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7
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Zhang H, Chen L, Gu G, Guo Z, Gong F, Wu S, Zhang X, He X. Clinical observation and nursing care on the prevention of abdominal organ cluster transplantation rejection. J Clin Nurs 2013; 22:1599-603. [PMID: 23387350 DOI: 10.1111/jocn.12079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Hongxia Zhang
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Lifen Chen
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Guangxiang Gu
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Zhiyong Guo
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Fengqiu Gong
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Shuwen Wu
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Xiaoyuan Zhang
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Xiaoshun He
- Department of Organ transplantation; the First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
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8
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Desai CS, Maegawa FB, Gruessner AC, Gruessner RW, Gruesner RW, Khan KM. Age-based disparity in outcomes of intestinal transplants in pediatric patients. Am J Transplant 2012; 12 Suppl 4:S43-8. [PMID: 22642508 DOI: 10.1111/j.1600-6143.2012.04107.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Outcomes of intestinal transplants (ITx; n = 977) for pediatric patients are examined using the United Network for Organ Sharing data from 1987 to 2009. Recipients were divided into four age groups: (1) <2 years of age (n = 569), (2) 2-6 years (n = 219), (3) 6-12 years (n = 121) and (4) 12-18 years (n = 68). Of 977 ITx, 287 (29.4%) were isolated ITx and 690 (70.6%) were liver and ITx (L-ITx). Patient survival for isolated ITx at 1, 3 and 5 years, 85.3%, 71.3% and 65.0%, respectively, was significantly better than L-ITx, 68.4%, 57.0% and 51.4%, respectively, (p = 0.0001); this was true for all age groups, except for patients <2 years of age. The difference in graft survival between isolated ITx and L-ITx was significant at 1 and 3 years (Wilcoxon test, p = 0.0012). After attrition analysis of graft survival of patients who survived past first year, 3 and 5 years, graft survival for L-ITx patient was significantly better than those for isolated ITx. Isolated ITx should be considered early before the onset of liver disease in children >2 with intestinal failure but is not advantageous in patients <2 years.
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Affiliation(s)
- C S Desai
- Department of Surgery, University of Arizona, Tucson, AZ, USA.
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Desai CS, Gruessner AC, Khan KM, Fishbein TM, Jie T, Rodriguez Rilo HL, Gruessner RW. Isolated intestinal transplants vs. liver-intestinal transplants in adult patients in the United States: 22 yr of OPTN data. Clin Transplant 2011; 26:622-8. [DOI: 10.1111/j.1399-0012.2011.01579.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Révillon Y, Chardot C. Indications and strategies for intestinal transplantation. J Pediatr Surg 2011; 46:280-3. [PMID: 21292073 DOI: 10.1016/j.jpedsurg.2010.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 11/04/2010] [Indexed: 02/01/2023]
Abstract
This lecture updates the pediatric surgeon on current indications, techniques, and results of intestinal transplantation in children with intestinal failure with reference to the Paris series.
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Affiliation(s)
- Yann Révillon
- Hôpital Necker-Enfants Malades, Université René Descartes, 75015 Paris, France.
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Arsenault DA, Potemkin AK, Robinson EM, Fallon EM, Ozonoff A, de Meijer VE, Puder M. Surgical intervention in the setting of parenteral nutrition-associated cholestasis may exacerbate liver injury. J Pediatr Surg 2011; 46:122-7. [PMID: 21238652 DOI: 10.1016/j.jpedsurg.2010.09.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/30/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compares postoperative markers of liver injury in patients receiving intravenous fish oil (IFO) with parenteral nutrition (PN)-associated cholestasis (PNAC) to patients with resolved PNAC. METHODS A retrospective review of all cholestatic-IFO patients undergoing abdominal laparotomy between March 1, 2007, and July 1, 2009, led to inclusion of 23 patients who collectively underwent 27 abdominal operations (13 pre-PNAC resolution and 14 post-PNAC resolution). Direct bilirubin (DB), total bilirubin, and alanine aminotransferase levels were examined over time in relation to operations. The time to resume presurgical trend of decreasing DB was calculated. RESULTS Sixty-nine percent (9/13) of pre-PNAC resolution procedures were associated with postoperative increase in DB compared with 7% (1/14) of post-PNAC resolution procedures associated with a recurrence of cholestasis (P = .02; odds ratio, 29.3; 95% confidence interval, 2.79-306.8). The median time to return to the preoperative downward trend of DB was 21 days. CONCLUSIONS Operations before PNAC resolution may be associated with an increased postoperative DB, possibly reflecting an exacerbation of liver injury. Operations post-PNAC resolution on IFO had a comparatively low incidence of postoperative cholestasis recurrence. Excepting clinical indication otherwise, it may be advisable to delay surgical intervention in the setting of PNAC in certain cases.
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Affiliation(s)
- Danielle A Arsenault
- Department of Surgery and The Vascular Biology Program, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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CD4+CD25+ T Cells Play a Complex Role in the Pediatric Combined Liver-Intestinal Graft Acceptance. Transplantation 2010; 90:95-7. [DOI: 10.1097/tp.0b013e3181d84cf7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Florescu D, Islam K, Grant W, Mercer D, Langnas A, Botha J, Nielsen B, Kalil A. Incidence and outcome of fungal infections in pediatric small bowel transplant recipients. Transpl Infect Dis 2010; 12:497-504. [DOI: 10.1111/j.1399-3062.2010.00542.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
This article reviews the current status of pediatric intestinal transplantation, focusing on referral and listing criteria, surgical techniques, patient management, monitoring, complications after transplant, and short- and long-term patient outcome. Intestine transplantation has become the standard of care for children who develop life-threatening complications associated with intestinal failure. The results of intestinal failure treatment have significantly improved in the last decade following the establishment of gut rehabilitation programs and advances in transplant immunosuppressive protocols, surgical techniques, and posttransplant monitoring. The 1-year patient survival is now 80% and more than 80% of the children who survive the transplant are weaned off parenteral nutrition. Early referral for pretransplant assessment and careful follow-up after transplant with prompt recognition and treatment of transplant-related complications are key factors contributing to superior patient outcomes and survival. The best results are being obtained at high-volume centers with survival rates of up to 75% at 5 years.
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Affiliation(s)
- Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury. Ann Surg 2009; 250:395-402. [PMID: 19661785 DOI: 10.1097/sla.0b013e3181b36657] [Citation(s) in RCA: 311] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective was to determine the safety and efficacy of a fish oil-based intravenous lipid emulsion (ILE) in the treatment of parenteral nutrition-associated liver disease (PNALD). SUMMARY AND BACKGROUND DATA PNALD can be a lethal complication in children with short bowel syndrome (SBS). ILE based on soybean oil administered with parenteral nutrition (PN) may contribute to its etiology. METHODS We performed an open-labeled trial of a fish oil-based ILE in 42 infants with SBS who developed cholestasis (serum direct bilirubin >2 mg/dL) while receiving soybean oil-based ILE. Safety and efficacy outcomes were compared with those from a contemporary cohort of 49 infants with SBS and cholestasis whose PN course included soybean ILE only. The primary efficacy end-point was time to reversal of cholestasis (direct bilirubin <=2 mg/dL). RESULTS Three deaths and 1 liver transplantation occurred in the fish oil cohort, compared with 12 deaths and 6 transplants in the soybean oil cohort (P = 0.005). Among survivors not transplanted during PN, cholestasis reversed while receiving PN in 19 of 38 patients in the fish oil cohort versus 2 of 36 patients in the soybean oil cohort. Based on Cox models, subjects receiving fish oil-based ILE experienced reversal of cholestasis 6 times faster (95% CI: 2.0-37.3) than those receiving soybean oil-based ILE. The provision of fish oil-based ILE was not associated with hypertriglyceridemia, coagulopathy, or essential fatty acid deficiency. Moreover, hypertriglyceridemic events and abnormal international normalized ratio levels were more common among controls. CONCLUSIONS Fish oil-based ILE is safe, may be effective in treating PNALD, and may reduce mortality and organ transplantation rates in children with SBS.
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Sauvat F, Grimaldi C, Lacaille F, Ruemmele F, Dupic L, Bourdaud N, Fusaro F, Colomb V, Jan D, Cezard JP, Aigrain Y, Revillon Y, Goulet O. Intestinal transplantation for total intestinal aganglionosis: a series of 12 consecutive children. J Pediatr Surg 2008; 43:1833-8. [PMID: 18926216 DOI: 10.1016/j.jpedsurg.2008.03.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 02/29/2008] [Accepted: 03/02/2008] [Indexed: 01/02/2023]
Abstract
BACKGROUND Management of patients with total intestinal aganglionosis (TIA) is a medical challenge because of their dependency on parenteral nutrition (PN). Intestinal transplantation (ITx) represents the only alternative treatment for patients with irreversible intestinal failure for achieving intestinal autonomy. METHODS Among 66 patients who underwent ITx in our center, 12 had TIA. They received either isolated ITx (n = 4) or liver-ITx (LITx, n = 8) after 10 to 144 months of total PN. All grafts included the right colon. RESULTS After a median follow-up of 57 months, the survival rate was 62.5% in the LITx group and 100% in the ITx patients. The graft survival rate was 62.5% in the LITx group and 75% in the ITx group. All the surviving patients were fully weaned from total PN, after a median of 57 days. Pull through of the colon allograft was carried out in all patients. Fecal continence is normal in all but one of the surviving children. CONCLUSION These results suggest that ITx with colon grafting should be the preferred therapeutic option in TIA. Early referral to a transplantation center after diagnosis of TIA is critical to prevent PN-related cirrhosis and thereby to permit ITx, which is associated with a good survival rate.
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Affiliation(s)
- Frederique Sauvat
- UFR Necker-Enfants Malades, University René Descartes Paris V, FAMA de Transplantation Intestinale, AP-HP and the National Reference Centre for Rare Digestive Diseases, Paris, France.
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17
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Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, Arsenault DA, Strijbosch RAM, Lopes S, Duggan C, Puder M. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 2008; 121:e678-86. [PMID: 18310188 DOI: 10.1542/peds.2007-2248] [Citation(s) in RCA: 368] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Parenteral nutrition-associated liver disease can be a progressive and fatal entity in children with short-bowel syndrome. Soybean-fat emulsions provided as part of standard parenteral nutrition may contribute to its pathophysiology. METHODS We compared safety and efficacy outcomes of a fish-oil-based fat emulsion in 18 infants with short-bowel syndrome who developed cholestasis (serum direct bilirubin level of > 2 mg/dL) while receiving soybean emulsions with those from a historical cohort of 21 infants with short-bowel syndrome who also developed cholestasis while receiving soybean emulsions. The primary end point was time to reversal of cholestasis (3 consecutive measurements of serum direct bilirubin level of < or = 2 mg/dL). RESULTS Among survivors, the median time to reversal of cholestasis was 9.4 and 44.1 weeks in the fish-oil and historical cohorts, respectively. Subjects who received fish-oil-based emulsion experienced reversal of cholestasis 4.8 times faster than those who received soybean emulsions and 6.8 times faster in analysis adjusted for baseline bilirubin concentration, gestational age, and the diagnosis of necrotizing enterocolitis. A total of 2 deaths and 0 liver transplantations were recorded in the fish-oil cohort and 7 deaths and 2 transplantations in the historical cohort. The provision of fish-oil-based fat emulsion was not associated with essential fatty acid deficiency, hypertriglyceridemia, coagulopathy, infections, or growth delay. CONCLUSIONS Parenteral fish-oil-based fat emulsions are safe and may be effective in the treatment of parenteral nutrition-associated liver disease.
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Affiliation(s)
- Kathleen M Gura
- Department of Pharmacy, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Zhao Y, Lu S, Cheng F, Hua YB, Wu WX, Wang XH. Immuno-protective effect of liver on small bowel in combined transplantation of liver and small bowel. Shijie Huaren Xiaohua Zazhi 2006; 14:1878-1883. [DOI: 10.11569/wcjd.v14.i19.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a new combined transplan-tation model of liver and small bowel in rats, and to investigate the protective effect of trans-planted liver on transplanted small bowel.
METHODS: Closed colony Sprague Dawley rats and inbred Wistar rats were included in this study. Five groups were designed: isogene small bowel transplant group (A), isogene liver transplant group (B), xenogene small bowel transplant group (C), xenogene liver transplant group (D), combined transplant of liver and small bowel group (E). Only Wistar rats were used in group A and B, while SD and Wistar rats were used as donors and recipients respectively in group C, D and E. During the combined transplantation of liver and small bowel (CTLS) for the donors, inferior vena cava in chest was cut to construct a muff in the lateral wall of portal vein and cuff was placed. During the operation for the recipients, portal veins of the donors and recipients were connected using cuff technique, and re-arterialization was completed by anastomosing the superior mesenteric artery of graft with the right kidney artery of the recipients. Randomly selected 4 rats from each group were sacrificed on postoperative days (POD) 5, 7 and 14, and grafts were sampled. The rejection of graft was investigated through histopathological analysis, and the apoptosis of the cells of graft were evaluated by TUNEL.
RESULTS: The survival rate of CTLS was 73.3% (22/30). The pathological changes of ischemia and reperfusion injury were observed in group A and B, and the numbers of apoptotic cells in the grafts were decreased with the prolonging of time. However, acute rejection after transplantation appeared in group C and D, and there were more apoptotic cells in the grafts. Mild, moderate and severe acute rejection occurred on POD 5, 7 and 14, respectively in group C, while only mild or severe acute rejection appeared in group E. Furthermore, the number of apoptotic cells in the grafts of group E was markedly decreased on POD 14 in comparison with that of group C (16.9 ± 4.3 vs 20.5 ± 6.3, P < 0.05). The degrees of acute rejection after transplantation and cell apoptosis of the grafts were not significantly different between group D and E.
CONCLUSION: The technique used in this study is feasible for establishment of CTLS model, and the transplanted liver can protect the transplanted intestinal graft from rejection in CTLS.
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