Intestinal transplantation in pediatric recipients younger than 1 year of age. indications and outcomes

Intestinal transplantation (ITx) is a proven treatment for pediatric patients with irreversible intestinal failure. Intestinal transplants in recipients younger than 1 year of age (<1yo) are infrequent and somewhat controversial. In the United States, only a few cases are performed each year in this age group. We retrospectively reviewed our experience with ITx in this particular population. Immunosuppression consisted of IL-2 receptors for induction and steroids, tacrolimus and sirolimus for maintenance. Thymoglobulin was administered per protocol to sensitized recipients or in the setting of a positive crossmatch During this period 337 ITx have been performed in 324 recipients at our institution. 161 transplants were performed in pediatric recipients (49.7% of the entire cohort). Of those, 34 cases (21.1%) were performed in <1yo recipients. The most common indication was Gastroschisis (10 cases) followed by Necrotizing Entercolitis and Atresia (8 and 7 cases respectively). The median age was 9 months old (range 5 to 11 mo). The median recipient weight was 7,4 kg (range 4 to 10Kg). Types of grafts were Liver-small bowel (and pancreas) transplant in 27 cases (79.4%), multivisceral tx in 6 cases and isolated intestinal transplant only 1 case. In this particular group of patients, 1-year and 3 year patient survival was 82.3%, compared to 84.4% and 71.4% for the entire cohort; and 88.1% and 79% respectively when considering only pediatric recipients. Technical (reoperation rates), and immunological complications(rejection, PTLD, GVHD) were not different among reciopients younger than 1 year of age and older pediatric recipients This study demonstrates that Intestinal Transplantion can be safely performed in pediatric recipients younger than 1 year of age. This data should favor the option of transplanting these patients in experienced centers versus waiting until they are older with other potential complications