Abstract
We performed 124 intestinal transplants on 108 children (median age, 1.5 years) since 1994. Initial graft types included isolated intestine (I) (n = 26), liver and intestine (LI) (n = 26), multivisceral (MV) (n = 50), and multivisceral without liver (MMV) (n = 6). Four groups were defined by type of induction therapy: none, OKT3, or cyclophosphamide (August 1994-December 1997, n = 25), early experience with daclizumab (January 1998-December 2000, n = 26), recent experience with daclizumab (January 2001–April 2004, n = 40), and Campath-1H (January 2001-April 2004, n = 17). Actuarial patient survival at 1 year for groups 1–4 was 44% ± 10%, 54% ± 10%, 83% ± 6%, and 41% ± 12%, respectively, with group 3 having the most favorable survival (P = 0.0004). Using Cox stepwise regression, the hazard rate of developing severe rejection was significantly higher in patients with transplant type I or LI (P = 0.0002), with no difference between these groups (P = 0.24) but a significantly higher rate for LI versus MV (P = 0.005). Three factors associated with improved patient survival were recipient of MV or MMV (P = 0.008), age at transplantation greater than 1 year (P = 0.01), and use of daclizumab (P = 0.0006). Cause-specific hazard analysis revealed a decreased rate of rejection-related mortality for recipients of MV or MMV (P = 0.0007), whereas age greater than 1 year indicated a lower rate of infection-related mortality (P = 0.0009). Pediatric intestinal transplantation provides an increasingly realistic chance of survival, particularly with the more recent use of daclizumab and multivisceral transplantation. A protective effect of multivisceral transplantation appears to exist with respect to the development of severe rejection.
