Complications in pediatric intestine transplantation in the absence of peri-operative donor or recipient bowel decontamination.
This study reports the clinical complication and infection rates of an active pediatric IT program that has never utilized bowel decontamination in either the donor or the recipient. All patients undergoing IT from 2003 to 2015 at a single pediatric IT center were reviewed. Post-transplant surgical, infectious, and immunosuppressive complications are reported. There were 52 patients who underwent IT during the study period. Among these patients, 4% developed a postoperative abscess, one developed an enteric fistula (2%), and one had an enteric or anastomotic leak (2%). The rate of any bacterial infection was 90% in the first year, with a wound infection rate of 23%. Any fungal infection occurred in 25% of patients. Any viral infection occurred in 75% of patients. Gastrointestinal viruses were diagnosed in 52% of patients, and cytomegalovirus infections occurred in 17%. Rejection rates were 39% at any time post-transplant (isolated 44% and 35% for multivisceral patients). At this center in which no bowel decontamination was used, rates of surgical complications, infections, and rejection were similar to those reported by other centers. These findings suggest bowel decontamination may provide no significant benefit in this population of high-risk transplant patients.
['Clouse|Jared W|JW|0000-0001-5320-8671', 'Kubal|Chandrashekhar A|CA|', 'Fridell|Jonathan A|JA|', 'Mangus|Richard S|RS|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D003666:Decontamination D005260:Female D006084:Graft Rejection D006801:Humans D007223:Infant D007422:Intestines D008297:Male D011183:Postoperative Complications D011300:Preoperative Care D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome
complications intestine transplant bowel decontamination bowel preparation multivisceral transplant outcomes