Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience

Cristina Dopazo; Girish L Gupte; Khalid Sharif; M Thamara P R Perera; Jane Hartley; Paolo Muiesan; David A Mayer; Peter Bromley; John Bennett; Deidre A Kelly; Indra van Mourik; Patrick McKiernan; Sue V Beath; Darius F Mirza

doi:10.1097/TP.0b013e318265c508

Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience

Cristina Dopazo, Girish L Gupte, Khalid Sharif, M Thamara P R Perera, Jane Hartley, Paolo Muiesan, David A Mayer, Peter Bromley, John Bennett, Deidre A Kelly, Indra van Mourik, Patrick McKiernan, Sue V Beath, Darius F Mirza

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

BACKGROUND: Intestinal transplantation is known to be associated with a high risk of early complications and mortality.

METHODS: We analyzed prospective data of 51 primary small bowel transplantations from December 1999 to August 2009 and identified perioperative factors that impact on early mortality (≤6 months after transplantation) after isolated intestinal (IITx; n=12) and combined liver-intestinal transplantation (CLITx group; n=39).

RESULTS: Ten patients died during the first 6 months after transplantation, all of them in CLITx group (n=10/51, 19%). Multivariate analyses demonstrated intraoperative red blood cell transfusion greater than 70 mL/kg (P=0.019, odds ratio [OR]=13.79) and base excess 30-min after reperfusion less than -16 (P=0.001, OR=14.05), thrombocytopenia (<50,000 per dL) between day 1 and day 15 after transplantation (P=0.047, OR=5.22), and occurrence of vascular complications (P=0.003, OR=8.96) during the posttransplantation period as predictors of early mortality in CLITx group.

CONCLUSION: Risk of mortality at 6 months after intestinal transplantation increased when the liver is included as combined graft. Strategies to reduce mortality such as refining selection for transplantation and early referral before the development of liver failure should be a priority.

Original language	English
Pages (from-to)	859-65
Number of pages	7
Journal	Transplantation
Volume	94
Issue number	8
DOIs	https://doi.org/10.1097/TP.0b013e318265c508
Publication status	Published - 27 Oct 2012

Keywords

Adolescent
Blood Platelets
Child
Child, Preschool
Female
Graft Rejection
Humans
Infant
Intestines
Kidney
Liver
Liver Transplantation
Male
Postoperative Complications
Risk Factors

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Dopazo, C., Gupte, G. L., Sharif, K., Perera, M. T. P. R., Hartley, J., Muiesan, P., Mayer, D. A., Bromley, P., Bennett, J., Kelly, D. A., van Mourik, I., McKiernan, P., Beath, S. V., & Mirza, D. F. (2012). Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience. Transplantation, 94(8), 859-65. https://doi.org/10.1097/TP.0b013e318265c508

@article{eac999c8e46f491ab5c95af4499442be,

title = "Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience",

abstract = "BACKGROUND: Intestinal transplantation is known to be associated with a high risk of early complications and mortality.METHODS: We analyzed prospective data of 51 primary small bowel transplantations from December 1999 to August 2009 and identified perioperative factors that impact on early mortality (≤6 months after transplantation) after isolated intestinal (IITx; n=12) and combined liver-intestinal transplantation (CLITx group; n=39).RESULTS: Ten patients died during the first 6 months after transplantation, all of them in CLITx group (n=10/51, 19%). Multivariate analyses demonstrated intraoperative red blood cell transfusion greater than 70 mL/kg (P=0.019, odds ratio [OR]=13.79) and base excess 30-min after reperfusion less than -16 (P=0.001, OR=14.05), thrombocytopenia (<50,000 per dL) between day 1 and day 15 after transplantation (P=0.047, OR=5.22), and occurrence of vascular complications (P=0.003, OR=8.96) during the posttransplantation period as predictors of early mortality in CLITx group.CONCLUSION: Risk of mortality at 6 months after intestinal transplantation increased when the liver is included as combined graft. Strategies to reduce mortality such as refining selection for transplantation and early referral before the development of liver failure should be a priority.",

keywords = "Adolescent, Blood Platelets, Child, Child, Preschool, Female, Graft Rejection, Humans, Infant, Intestines, Kidney, Liver, Liver Transplantation, Male, Postoperative Complications, Risk Factors",

author = "Cristina Dopazo and Gupte, {Girish L} and Khalid Sharif and Perera, {M Thamara P R} and Jane Hartley and Paolo Muiesan and Mayer, {David A} and Peter Bromley and John Bennett and Kelly, {Deidre A} and {van Mourik}, Indra and Patrick McKiernan and Beath, {Sue V} and Mirza, {Darius F}",

year = "2012",

month = oct,

day = "27",

doi = "10.1097/TP.0b013e318265c508",

language = "English",

volume = "94",

pages = "859--65",

journal = "Transplantation",

issn = "0041-1337",

publisher = "Lippincott Williams and Wilkins",

number = "8",

}

Dopazo, C, Gupte, GL, Sharif, K, Perera, MTPR, Hartley, J, Muiesan, P, Mayer, DA, Bromley, P, Bennett, J, Kelly, DA, van Mourik, I, McKiernan, P, Beath, SV & Mirza, DF 2012, 'Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience', Transplantation, vol. 94, no. 8, pp. 859-65. https://doi.org/10.1097/TP.0b013e318265c508

TY - JOUR

T1 - Combined liver-intestine grafts compared with isolated intestinal transplantation in children

T2 - a single-center experience

AU - Dopazo, Cristina

AU - Gupte, Girish L

AU - Sharif, Khalid

AU - Perera, M Thamara P R

AU - Hartley, Jane

AU - Muiesan, Paolo

AU - Mayer, David A

AU - Bromley, Peter

AU - Bennett, John

AU - Kelly, Deidre A

AU - van Mourik, Indra

AU - McKiernan, Patrick

AU - Beath, Sue V

AU - Mirza, Darius F

PY - 2012/10/27

Y1 - 2012/10/27

N2 - BACKGROUND: Intestinal transplantation is known to be associated with a high risk of early complications and mortality.METHODS: We analyzed prospective data of 51 primary small bowel transplantations from December 1999 to August 2009 and identified perioperative factors that impact on early mortality (≤6 months after transplantation) after isolated intestinal (IITx; n=12) and combined liver-intestinal transplantation (CLITx group; n=39).RESULTS: Ten patients died during the first 6 months after transplantation, all of them in CLITx group (n=10/51, 19%). Multivariate analyses demonstrated intraoperative red blood cell transfusion greater than 70 mL/kg (P=0.019, odds ratio [OR]=13.79) and base excess 30-min after reperfusion less than -16 (P=0.001, OR=14.05), thrombocytopenia (<50,000 per dL) between day 1 and day 15 after transplantation (P=0.047, OR=5.22), and occurrence of vascular complications (P=0.003, OR=8.96) during the posttransplantation period as predictors of early mortality in CLITx group.CONCLUSION: Risk of mortality at 6 months after intestinal transplantation increased when the liver is included as combined graft. Strategies to reduce mortality such as refining selection for transplantation and early referral before the development of liver failure should be a priority.

AB - BACKGROUND: Intestinal transplantation is known to be associated with a high risk of early complications and mortality.METHODS: We analyzed prospective data of 51 primary small bowel transplantations from December 1999 to August 2009 and identified perioperative factors that impact on early mortality (≤6 months after transplantation) after isolated intestinal (IITx; n=12) and combined liver-intestinal transplantation (CLITx group; n=39).RESULTS: Ten patients died during the first 6 months after transplantation, all of them in CLITx group (n=10/51, 19%). Multivariate analyses demonstrated intraoperative red blood cell transfusion greater than 70 mL/kg (P=0.019, odds ratio [OR]=13.79) and base excess 30-min after reperfusion less than -16 (P=0.001, OR=14.05), thrombocytopenia (<50,000 per dL) between day 1 and day 15 after transplantation (P=0.047, OR=5.22), and occurrence of vascular complications (P=0.003, OR=8.96) during the posttransplantation period as predictors of early mortality in CLITx group.CONCLUSION: Risk of mortality at 6 months after intestinal transplantation increased when the liver is included as combined graft. Strategies to reduce mortality such as refining selection for transplantation and early referral before the development of liver failure should be a priority.

KW - Adolescent

KW - Blood Platelets

KW - Child

KW - Child, Preschool

KW - Female

KW - Graft Rejection

KW - Humans

KW - Infant

KW - Intestines

KW - Kidney

KW - Liver

KW - Liver Transplantation

KW - Male

KW - Postoperative Complications

KW - Risk Factors

U2 - 10.1097/TP.0b013e318265c508

DO - 10.1097/TP.0b013e318265c508

M3 - Article

C2 - 23018880

SN - 0041-1337

VL - 94

SP - 859

EP - 865

JO - Transplantation

JF - Transplantation

IS - 8

ER -

Combined liver-intestine grafts compared with isolated intestinal transplantation in children: a single-center experience

Abstract

Keywords

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