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Amin A, Emmanuel B, Raghu V, Khanna A, Soltys K, Sindhi R, Tevar A, Moritz ML, Humar A, Mazariegos G, Ganoza A. Kidney transplant in pediatric gut transplant recipients - Technical challenges and outcomes. Pediatr Transplant 2024; 28:e14744. [PMID: 38566341 DOI: 10.1111/petr.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND There is limited data in the literature about pediatric kidney transplant (KT) following gut transplant (GT). The purpose of this study is to highlight the technical challenges and outcomes of KT in pediatric gut recipients who developed kidney failure (KF). METHODS A retrospective single-center study of pediatric GT recipients from January 2000 to December 2019 was performed. In total, 14 (7%) out of 206 pediatric GT recipients developed KF and were listed for KT. Ten patients underwent kidney after gut transplant (KAGT), three patients underwent simultaneous kidney and re-do gut transplant (SKAGT), and one patient died on the KT waitlist. RESULTS 1-, 5-, and 10-year kidney graft survival was 100%, 91%, and 78%, respectively. 1-, 5-, and 10-year GT graft survival was 100%, 77%, and 77%, respectively. 1-, 5-, and 10-year patient survival was 100%, 91%, and 91%, respectively. CONCLUSION Despite the technical complexity, KAGT and SKAGT for pediatric GT recipients that develop KF can be performed with favorable outcomes.
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Affiliation(s)
- Arpit Amin
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bishoy Emmanuel
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vikram Raghu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ajai Khanna
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle Soltys
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rakesh Sindhi
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amit Tevar
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael L Moritz
- Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - George Mazariegos
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Department of Surgery, Hillman Center for Pediatric Transplantation and Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chang YT, Soltys K, Khanna A, Bond GJ, Ganoza A, Rudolph JA, Sindhi R, Mazariegos GV. Long-term outcomes of intestinal transplantation from donors aged under 1 year. Pediatr Transplant 2022; 26:e14257. [PMID: 35195934 DOI: 10.1111/petr.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/07/2022] [Accepted: 02/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to analyze the long-term outcomes of transplants utilizing ITx donors <1 year and to compare these results with older donors. METHODS Between January 2007 and December 2019, the primary ITx donors in the Children's Hospital of Pittsburgh of UPMC were retrospectively reviewed. Short- and long-term outcomes of recipients receiving a deceased donor organ from donors <1 year were compared with those found in all other recipients. RESULTS During the study period, there were 89 primary ITx donors, using 30 donors (33.7%) aged <1 year. The mean age of their recipients was 1.6 ± 0.7 (0.7-3.2) years. The 30 graft types were isolated intestine (n = 3, 10.0%), liver bowel (n = 20, 66.7%), and multivisceral (n = 7, 23.3%). Technical complications occurred in 12 (40.0%) recipients. Candidates transplanted with intestine allografts from donors <1 year of age had shorter wait times (p < .001), more liver-inclusive grafts (p < .001), and less donor-specific antibodies (DSA) (p = .014). During follow-up, the recipients had less graft loss (p = .018), and more remained alive with graft in place (p = .011). Among children transplanted with such donors, 3-year and graft survival rates were 86.7% and 82.9% compared to 62.8% and 49.9% in the cohort of donors >1 year (p = .032 and .011). CONCLUSIONS Donor age <1 year was associated with improved graft survival. Optimal utilization of this population for toddler candidates would increase intestine availability, reduce time to transplantation, and potentially improve long-term outcome.
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Affiliation(s)
- Yu-Tang Chang
- Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Kyle Soltys
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Ajai Khanna
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Geoffrey J Bond
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jeffrey A Rudolph
- Division of Gastroenterology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Rakesh Sindhi
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - George V Mazariegos
- Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Lee J, Balasubramanya S, Agopian VG. Solid Organ Transplantation. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Muto M, Kaji T, Onishi S, Yano K, Yamada W, Ieiri S. An overview of the current management of short-bowel syndrome in pediatric patients. Surg Today 2021; 52:12-21. [PMID: 33464414 DOI: 10.1007/s00595-020-02207-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
Short-bowel syndrome (SBS) is defined as a state of malabsorption after resection or loss of a major portion of the bowel due to congenital or acquired factors. This article presents an overview on the recent management of pediatric SBS. The pediatric SBS population is very heterogeneous. The incidence of SBS is estimated to be 24.5 per 100,000 live births. The nutritional, medical, and surgical therapies available require a comprehensive evaluation. Thus, multidisciplinary intestinal rehabilitation programs (IRPs) are necessary for the management of these complex patients. The key points of focus in IRP management are hepato-protective strategies to minimize intestinal failure-associated liver disease; the aggressive prevention of catheter-related bloodstream infections; strategic nutritional supply to optimize the absorption of enteral calories; and the management and prevention of small bowel bacterial overgrowth, nephrocalcinosis, and metabolic bone disease. As the survival rate of children with SBS currently exceeds 90%, the application of small bowel transplantation has been evolving. The introduction of innovative treatments, such as combined therapy of intestinotrophic hormones, including glucagon-like peptide-2, may lead to further improvements in patients' quality of life.
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Affiliation(s)
- Mitsuru Muto
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima, 890-8520, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
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Kim YY, Kim MI, Jeong E, Lee JM. Organ donation from brain-dead pediatric donors in Korea: A 5-year data analysis (2013-2017). Pediatr Transplant 2020; 24:e13686. [PMID: 32128967 DOI: 10.1111/petr.13686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/21/2022]
Abstract
In Korea, 2-4% of brain-dead organ donations are from donors <16 years of age. We aimed to identify the current status of and challenges in pediatric organ donation from brain-dead donors in Korea. We performed a retrospective analysis using data from KONOS between January 1, 2013, and December 31, 2017. Our research identified 107 pediatric donors aged <16 years, representing 4.4% of all donors in Korea between 2013 and 2017. The consent rate was higher in PDs than in adult donors (47.0% vs 44.9%). The most common cause of brain death in PDs was hypoxia (28.0%), followed by brain tumor and trauma, whereas that in ADs was brain hemorrhage/stroke (42.4%), followed by trauma and hypoxia (P < .001). In both groups, the kidney (PDs vs ADs: 75.7% vs 88.5%), liver (58.9% vs 46.2%), and heart (32.7% vs 29.7%) were the organs most commonly transplanted. However, pancreatic (PDs vs ADs: 30.0% vs 11.7%, P < .001) and small bowel transplantations (4.7% vs 0.2%, P < .001) were more common in PDs, whereas lung (7.5% vs 14.5%, P = .046) and corneal transplantations (14.0% vs 36.2%) were more common in ADs. Only a small proportion of organ donations in Korea are from PDs, but this rate has been maintained. Given the current status of brain-dead pediatric organ donation, a more active approach is required to bring about improvement.
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Affiliation(s)
- Yong Yeup Kim
- Department of Surgery, Korea University Medical Center, Seoul, Korea
| | - Mi-Im Kim
- Transplantation Center, Korea University Anam Hospital, Seoul, Korea
| | - Eunsil Jeong
- Transplantation Center, Korea University Anam Hospital, Seoul, Korea
| | - Jae-Myeong Lee
- Department of Acute Care Surgery, Korea University Anam Hospital, Seoul, Korea
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Intestinal re-transplantation: indications, techniques and outcomes. Curr Opin Organ Transplant 2019; 23:224-228. [PMID: 29465439 DOI: 10.1097/mot.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The field of intestinal transplantation has shown significant growth and has become the gold standard therapy for patients that suffer from the complications of total parenteral nutrition due to irreversible intestinal failure. In the early years of intestinal transplant, retransplantation was associated with extremely high morbidity and mortality. The purpose of this review is to summarize recent encouraging reports, showing significant improvement in outcomes after intestinal retransplantation. RECENT FINDINGS Recent studies at large volume centers have reported significant progress in patient and graft survival after intestinal retransplantation. Recent literature described the most common indications for retransplantation, surgical techniques, timing of graft enterectomy, immunologic monitoring, and complications. Improvement in outcomes due to advances in immunosuppression management and the importance of liver-containing grafts are also described. SUMMARY Improving early to midterm patient and graft survival has made consideration for intestinal retransplantation even more necessary. Current clinical evidence supports the benefit of intestinal retransplantation in well selected recipients. Initial immunosuppression protocols, technical modifications, proper timing of enterectomy, and improved infectious disease monitoring have contributed to improved outcomes.
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Pinto F, Fernandes E, Virella D, Abrantes A, Neto M. Born Preterm: A Public Health Issue. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2019. [DOI: 10.1159/000497249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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