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Oral Communications 1
7.210 - Relevance of Intestinal Transplant Criteria in the New Era of Specialized Care for Intestinal Failure
Presenter: Karolina, Burghardt, , Canada Authors: Karolina M. Burghardt1,2, Paul W. Wales2,3, Nicole de Silva3, David Grant1,2, Yaron Avitzur1,2,3
Relevance of Intestinal Transplant Criteria in the New Era of Specialized Care for Intestinal Failure
Karolina M. Burghardt1,2, Paul W. Wales2,3, Nicole de Silva3, David Grant1,2, Yaron Avitzur1,2,3
1Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada; 1Necker Hospital, Paris, France; 2Transplant Center , Hospital for Sick Children, Toronto, ON, Canada; 3Group for the Improvement of Intestinal Function and Treatment (GIFT), Hospital for Sick Children, Toronto, ON, Canada
The indications for intestinal transplantation (ITx) were developed in 2001 and have remained unchanged for the past decade despite improved treatments and outcome for intestinal failure (IF). Aim: To assess the predictive value of the recommended indications for ITx in the current era of specialized care for IF. Methods: The sensitivity, specificity, NPV and PPV of the criteria (conjugated bilirubin>100 μmol/l, loss of >50% of vascular access sites, ≥2 episodes of sepsis/yr, ultra short bowel) were calculated and compared in 2 cohorts of children with IF; old era – 1998-2005 (N=99) and current era – 2006-2011 (N=91). Patient outcome was defined as either alive or dead/transplanted (isolated liver, small bowel or liver-small bowel transplant) at the end of the follow-up. Results: 33 (33%) children died and 7 (7%) underwent transplant in the old era compared to 16 (17%) and 9 (10%) in the new era, respectively. Median follow-up since the onset of IF was 587 days in the old era and 572 days in the current era. The PPV and sensitivity of the criteria of progressive liver disease (PPV 64% in the old era vs. 40% in the current era; sensitivity 84% vs. 65% respectively) and ultra short bowel (PPV 100% in the old era vs. 9% in the current era; sensitivity 10% vs 4% respectively) have decreased in the new era, reflecting improved patient outcome. Meanwhile, a history of significant loss of vascular access or multiple episodes of sepsis had a poor predictive value in both eras with low PPV (≤50%) and sensitivity (≤63%). Conclusions: The currently endorsed pediatric ITx listing criteria have limited prognostic value with low sensitivity and PPV in the modern era of specialized IF care. The listing criteria recommended for ITx in children need to be updated to reflect improvements in the interdisciplinary treatment of chronic IF.
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