Improved outcome of referrals for intestinal transplantation in the UK

Girish L. Gupte, Susan V. Beath, Sue Protheroe, M. Stephen Murphy, Paul Davies, Khalid Sharif, Patrick J. McKiernan, Jean De Ville De Goyet, Ian W. Booth, Deirdre A. Kelly

Research output: Contribution to journalArticle

Abstract

Aim: To describe the outcome of children with intestinal failure referred to Birmingham Children's Hospital (BCH) for consideration of intestinal transplantation (ITx), to determine factors for an adverse outcome and to analyse the impact of post-1998 strategies on survival. Subjects and methods: A retrospective analysis was performed of children referred for ITx assessment from January 1989 to December 2003. Children were assessed by a multidisciplinary team and categorised into: (a) stable on parenteral nutrition; (b) unsuitable for transplantation (Tx); and (c) recommended for Tx. To analyse the impact of the post-1998 strategies on survival, a comparison was made between the two eras (pre-1998 and post-1998). Results: 152 children with chronic intestinal failure were identified (63M:89F, median age 10 months (range 1-170)). After assessment, 69 children were considered stable on parenteral nutrition (5-year survival 95%); 28 children were unsuitable for Tx (5-year survival 4%); and 55 children were recommended for Tx (5-year survival 35%, which includes 14 children who died waiting for size-matched organs). Twenty three ITx and nine isolated liver transplants (iLTx) were performed. In a multivariate analysis, the following factors in combination had an adverse effect on survival: the presence of a primary mucosal disorder (p = 0.007, OR ratio 3.16, 95% CI 1.37 to 7.31); absence of involvement of a nutritional care team at the referring hospital (p=0.001, OR ratio 2.55, 95% CI 1.44 to 4.52); and a serum bilirubin>100 μmol/l (p=0.001, OR ratio 3.70, 95% CI 1.84 to 7.47). Earlier referral (median serum bilirubin 78 μmol/l in the post-1998 era compared with 237 μmol/l in the pre-1998 era, p = 0.001) may be a contributory factor to improved survival. The strategies of combined en bloc reduced liver/small bowel transplantation and iLTx resulted in fewer deaths on the waiting list in the post-1998 era (2 deaths in post-1998 era v 12 deaths in pre-1998 era). The overall 3-year survival in the post-1998 era (69%) has improved compared with the pre-1998 era (31%; p

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalArchives of Disease in Childhood
Volume92
Issue number2
DOIs
Publication statusPublished - Feb 2007

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Referral and Consultation
Transplantation
Parenteral Nutrition
Bilirubin
Waiting Lists
Organ Size
Liver
Serum
Multivariate Analysis
Transplants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Gupte, G. L., Beath, S. V., Protheroe, S., Murphy, M. S., Davies, P., Sharif, K., ... Kelly, D. A. (2007). Improved outcome of referrals for intestinal transplantation in the UK. Archives of Disease in Childhood, 92(2), 147-152. https://doi.org/10.1136/adc.2005.090068

Improved outcome of referrals for intestinal transplantation in the UK. / Gupte, Girish L.; Beath, Susan V.; Protheroe, Sue; Murphy, M. Stephen; Davies, Paul; Sharif, Khalid; McKiernan, Patrick J.; De Goyet, Jean De Ville; Booth, Ian W.; Kelly, Deirdre A.

In: Archives of Disease in Childhood, Vol. 92, No. 2, 02.2007, p. 147-152.

Research output: Contribution to journalArticle

Gupte, GL, Beath, SV, Protheroe, S, Murphy, MS, Davies, P, Sharif, K, McKiernan, PJ, De Goyet, JDV, Booth, IW & Kelly, DA 2007, 'Improved outcome of referrals for intestinal transplantation in the UK', Archives of Disease in Childhood, vol. 92, no. 2, pp. 147-152. https://doi.org/10.1136/adc.2005.090068
Gupte GL, Beath SV, Protheroe S, Murphy MS, Davies P, Sharif K et al. Improved outcome of referrals for intestinal transplantation in the UK. Archives of Disease in Childhood. 2007 Feb;92(2):147-152. https://doi.org/10.1136/adc.2005.090068
Gupte, Girish L. ; Beath, Susan V. ; Protheroe, Sue ; Murphy, M. Stephen ; Davies, Paul ; Sharif, Khalid ; McKiernan, Patrick J. ; De Goyet, Jean De Ville ; Booth, Ian W. ; Kelly, Deirdre A. / Improved outcome of referrals for intestinal transplantation in the UK. In: Archives of Disease in Childhood. 2007 ; Vol. 92, No. 2. pp. 147-152.
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