Last Updated: 2010-02-08 16:47:21 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Survival after pediatric intestinal transplantation seems to be related to the indication for transplant, according to researchers who analyzed data from the United Network for Organ Sharing (UNOS).
The study - the largest ever of pediatric intestinal transplants -- found that children with volvulus have higher survival rates than those with other conditions.
"Intestinal transplant is increasingly being used to treat children with intestinal failure," Dr. Oliver B. Lao, from the University of Washington, Seattle, and colleagues write in their report. They note that in the past decade, referrals for pediatric intestinal transplantation have doubled.
But, the authors add, "the survival rates after pediatric intestinal transplant according to underlying disease are unknown."
To investigate, they used UNOS data to identify 852 children who received intestinal transplants between January 1991 and May 2008.
The median age and weight at transplant were 1 year and 10.7 kg, according to the report in the March issue of Pediatrics. Simultaneous liver transplantation was done in 69% of cases.
The most common underlying disorder was gastroschisis (24%), followed by functional bowel problems (16%), necrotizing enterocolitis (15%), volvulus (14%), and Hirschsprung disease (7%). Other indications were seen in 19%.
Overall actuarial survival rates at 1, 3, and 5 years were 73%, 61%, and 55%, respectively. At all three of those points, volvulus patients had the highest survival rates: 82%, 79%, and 73%.
On multivariate analysis, with gastroschisis as the referent, the hazard ratios for mortality were 0.46 with transplantation for volvulus, 0.81 for Hirschsprung's disease, 0.91 for functional bowel problems, 1.14 for short-gut syndrome, and 1.25 for necrotizing enterocolitis.
"Future research should identify what factors (preexisting bowel length, length of time on parenteral nutrition, degree of liver dysfunction, or other comorbid conditions) allow certain groups to demonstrate improved outcomes," the authors state.
"In doing so, we may be able to improve the outcomes of all children receiving an intestinal transplant," they conclude.
Pediatrics 2010;125:e1-e9.
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