Tuesday September 15, 2020 - 14:30 to 15:15
Grafted colon in intestinal transplantation: Does it make a difference in patients outcome?
Javier J. Serradilla1, Alba Bueno1, Ane Miren AM Andrés1, Esther E. Ramos2, Alida A. Alcolea2, Francisco F. Hernández1,3, Manuel M. López-Santamaría1.
1Pediatric Surgery, La Paz University Hospital, Madrid, Spain; 2Pediatric Gastroenterology and Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain; 3ERN-Transplantchild, IdiPaz, Madrid, Spain
Introduction: To include the colon as part of an intestinal or multivisceral graft is still a matter of debate. While some groups consider that it might be important for water absorption and residue breakdown without posing risks to patients, others state that its inclusion could result in an increase in infectious complications. Our aim was to analyze if the presence of the grafted colon in our patients has meant differences in their outcome.
Methods: Retrospective review of our historical series of intestinal and multivisceral transplants comparing patients that received a colon as part of the graft to those that didn’t.A total of 107 patients received an intestinal or multivisceral graft between 1999-2018. Main indications were short gut syndromes (60 patients, 56.1%), motility disorders (16 patients, 15%) and untreatable diarrheas (14 patients, 13.1%). It was used a graft without colon in 61[group no colon(33 M, 28 F)] andwith colon in 46 [group colon (27 M, 19 F)].We compared the appearance of complications (such as rejection or infections) and survival curves adjusted by treatment protocol.A p-value below 0.05 was considered statistically significant.
Results: Average ages and weights at transplantwere similar in both groups, with 67.5 months (6-361) and 17.2 Kg (4-52.7) in patients without a grafted colon and 64 months (6-216) and 16 Kg (3-59.2) in patients with colon. One hundred and two patients had a small bowel stoma. Timing of stoma take-down was similar in no colon group compared to colon group, with a median of 9.5 (1-125) months and 8 (1-50) months respectively. Rates of acute and chronic rejection were similar in both groups (39%/10% no colon vs35%/4%colon).Rates of GVHD (15% no colon vs15% colon) and PTLD (20% no colon vs13% colon)were also similar. Median of septic episodes was 2 in both [no colon (0-8),colon (0-6)].Among the multiple infectious agents analyzed, only clostridium showed astatistically significant higher rate of infection in colon group (2% no colon vs15% colon). Patient and graft survival, adjusted by immunosuppression protocols, did not show differences.
Conclusion: Colon inclusion as part of the intestinal graft does not produce a higher rejection, GVHD or PTLD rates, nor a survival decrease. Even though the infection rate is also similar, there are differences in the infectious agents between the groups.