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      Trasplante intestinal en pediatría: Análisis de la primera serie de receptores en la Argentina Translated title: Intestinal transplantation in pediatrics: Analysis of the first recipient series in Argentina

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          Abstract

          El presente trabajo comunica la evolución posoperatoria inmediata y alejada de los pacientes pediátricos trasplantados en un único centro en la Argentina, desde marzo de 2006 hasta marzo de 2010, en variables demográficas, indicaciones, contraindicaciones, evolución y supervivencia de pacientes e injerto. Basándose en los resultados se puede concluir que el trasplante intestinal debe ser considerado como un tratamiento válido para todos aquellos pacientes que presenten insuficiencia intestinal, con complicaciones del soporte parenteral. Los resultados adquiridos en nuestro programa son similares a los comunicados internacionalmente y abren una nueva perspectiva para un grupo especial de niños que carecían de solución en nuestro medio.

          Translated abstract

          The present is a retrospective analysis of all pediatric patients that underwent intestinal transplant from march 2006 to march 2010, describing demographics, indications, contraindications, clinical follow up and survival in a single center in Argentina. Based on the results shown one can conclude that intestinal transplant should be considered as a valid treatment for patients with intestinal insufficiency and complications related to parenteral nutrition. The results of our program are similar to those reported in the international Intestinal Transplant Registry. This opens a new perspective to a special population that otherwise would not have any other therapeutic option.

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          Intestinal transplantation for short bowel syndrome and gastrointestinal failure: current consensus, rewarding outcomes, and practical guidelines.

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            Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants.

            The United Network for Organ Sharing (UNOS) reports indicate that mortality on the intestine transplant waiting list is higher than on other transplant waiting lists. The goals of this study were (1) to determine whether most of the intestinal transplant candidate deaths have occurred in those who also need liver transplants, and (2) to compare the waiting list mortality in the liver-intestine candidate subset with the overall liver transplant candidate population. We found that 90% of intestine transplant waiting list deaths have occurred in candidates who also needed liver transplants. Since 1994, annual mortality has been higher in liver-intestine transplant candidates than in the overall liver transplant candidate population, and these differences have been statistically significant since 1996. These mortality differences applied to all age groups. Also, status 2B, 3, and 7 candidate mortality was significantly higher in liver-intestine candidates than in the overall liver transplant candidate population. Because there were so few liver-intestine transplant candidates listed as status 1 or 2A, a meaningful comparison was not possible in these statuses. These data indicate that liver-intestine transplant candidates are a unique subset of liver transplant candidates with a significantly higher risk of dying on the waiting list. Recent changes in UNOS liver allocation policy that gives higher priority to liver-intestine candidates may help to reduce this discrepancy. However, further research into the etiology of liver disease in patients on long-term parenteral nutrition and earlier referral of high-risk short bowel syndrome patients to centers with special expertise in their management are needed for an ultimate solution to this problem.
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              Isolated intestinal transplantation: proof of clinical efficacy.

              Isolated intestinal transplantation has been limited by poor patient and graft survival. If high survival could be achieved and if parenteral nutrition-associated liver disease were reversible, this procedure could be more widely applied, with early liver dysfunction indicating the need for transplant evaluation. Twenty-six patients who had failed parenteral nutrition received 28 isolated intestinal transplants. We analyzed patient and graft survival, the effect of sirolimus on the severity and frequency of rejection, and the reversibility of liver dysfunction after transplant. Three-year actuarial patient and primary graft survival were 88% and 71%, respectively. Two patients underwent successful retransplants. Twenty-two patients are alive at a mean of 21+/-15 (median 18; range 3-51) months. Actuarial survival with freedom from parenteral support is 81% at 3 years (21 of 26 patients). Actuarial freedom from parenteral support among survivors is 95.5% at 3 years (21 of 22 patients). Early rejection was less frequent with sirolimus (34% vs. 70% without sirolimus) (P=0.007). Moderate and severe rejection was less frequent with sirolimus (1/11 episodes vs. 9/17 episodes without sirolimus) (P=0.05). No grafts were lost after introduction of sirolimus. In all four patients with advanced liver dysfunction, fibrosis and cholestasis regressed within 1 year. High patient survival and parenteral nutrition-free survival can be achieved after isolated intestinal transplantation. Sirolimus treatment has eliminated graft loss. Parenteral nutrition-associated liver disease is reversible with intestinal transplantation. Refractory liver dysfunction in patients receiving parenteral nutrition should prompt consideration for isolated intestinal transplantation.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aap
                Archivos argentinos de pediatría
                Arch. argent. pediatr.
                Sociedad Argentina de Pediatría (Buenos Aires )
                1668-3501
                April 2011
                : 109
                : 2
                : 135-141
                Affiliations
                [1 ] Hospital Universitario Fundación Favaloro Argentina
                [2 ] Hospital Universitario Fundación Favaloro Argentina
                [3 ] Hospital Universitario Fundación Favaloro Argentina
                [4 ] Hospital Universitario Fundación Favaloro Argentina
                Article
                S0325-00752011000200008
                9488a6b9-e730-4c4a-97c7-9d9262282432

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Argentina

                Self URI (journal page): http://www.scielo.org.ar/scielo.php?script=sci_serial&pid=0325-0075&lng=en
                Categories
                PEDIATRICS

                Pediatrics
                Parenteral nutrition,Intestinal insufficiency,Multiorgan transplant,Trasplante de intestino,Nutrición parenteral,Insuficiencia intestinal,Trasplante multiorgánico,Intestinal transplant

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