What happens to very late survivors after small bowel transplantation?
Olivier Corcos1, Florence Lacaille2, Olivier Goulet2, Cecile Talbotec2, Alexandra Bisbal1, Yves Panis3, Christophe Chardot4, Francisca Joly1
1Gastroenterology and Intestinal Failure, Beaujon hospital, Clichy, France; 2Pediatric Hepatogastroenterology-Nutrition, Necker-Enfants Malades Hospital, Paris, France; 3Department of Colorectal Surgery and Intestinal Transplantation, Beaujon Hospital, Clichy, France; 4Surgical Pediatry and Transplantation, Necker-Enfants Malades Hospital, Paris, France
Introduction : Very late survival, >10 years, is possible after SBT even in case of graft removal. Despite various, frequent and severe early and late complications, SBT children recipients may reach the adult age and have a prolonged survival, with or without a functional intestinal graft.
Methods : From our cohort of 97 children who received 105 SBT we selected all survivors over 10 years after SBT. We retrospectively studied their personal and growth outcome, toxicomany and professional insertion. Study period was defined between the date of 10y after SBT to death or end of follow-up.
Results : Intestinal transplantation consisted in L-SBT n=19, isolated SBT n=7, including colon n=16. Median age at transplantation was 4,6 years. From 26 living recipients 10 years after SBT, 5 died (age 21 years) during study period and 21 very late survivors (VLS) were still alive (mean age 21 years), 2 with graft loss. 16 patients reached the adult age. The latest follow-up concerns a 5 months old children, transplanted in 1989, still living 24 years after with a functional intestinal graft. Maintenance IS in the 19/21 VLS included tacrolimus/steroids (n=19), mycophenolate (n=4), rapamycine (n= 2). Median weights and heights of 21 VLS were 51 (26-60) kgs and 160 (120-173) cm, respectively. 76% of VLS were weaned off PN. 17/26 (65%) VLS had education and a profession, 11/26 (42%) had social and professional difficulties, 5/26 (19%) suffered from toxicomany/alcoolism. Among the 22 recipients who reached the age of 18 years (85%), none married or had children.
Conclusion : Very late survivors of SBT reach the adult age with personal difficulties, that need to be prevented and accompanied in a multidisciplinary and global management, with special attention during the transition period.