Beyond 10 years, with or without an intestinal graft: Present and future?
| Autor: | Olivier Corcos, Christophe Chardot, Sophie Courbage, Louise Galmiche, Florence Lacaille, Cécile Lambe, Olivier Goulet, Marion Rabant, Danielle Canioni, Francisca Joly, Cécile Talbotec |
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| Rok vydání: | 2020 |
| Předmět: |
Graft Rejection
medicine.medical_specialty medicine.medical_treatment 030230 surgery Liver transplantation Gastroenterology Article 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) Child Sirolimus Transplantation business.industry Graft Survival Mycophenolic Acid Micronutrient Fat malabsorption Regimen surgical procedures operative Parenteral nutrition Complication business Immunosuppressive Agents medicine.drug |
| Zdroj: | Am J Transplant |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.15899 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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