Surgical complications after intestinal transplantation in infants and children-UK experience

Girish L. Gupte, Koroush S. Haghighi, Khalid Sharif, David A. Mayer, Susan V. Beath, Deirdre A. Kelly, John Buckels, Jean Deville De Goyet, Darius F. Mirza, Alastair J. Millar

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Surgical complications have a significant impact on morbidity and mortality following intestinal transplantation (ITx). Birmingham Children's Hospital commenced intestinal transplantation in 1993 and the following surgical strategies evolved: (a) pretransplant abdominal tissue expanders, 1998; (b) combined en-bloc reduced liver and intestinal transplantation (CRLITx), 1998; (c) staged abdominal closure, 2001; (d) preservation of graft duodenal artery, 2005. Aim: An internal audit was performed to document the surgical complications after ITx and to evaluate strategies in the management and prevention of complications. Methods: A retrospective analysis of the medical records from January 1993 to June 2007 was conducted to identify surgical complications, evaluate management strategies, and report outcome following ITx. Results: Forty-six children underwent 49 ITx (9 isolated intestinal, 39 combined liver and intestinal [CLITx], and 1 multivisceral transplant). Twenty three children had CRLITx since 1998, although there were none before 1997. The median donor: recipient weight ratio in CLITx was 2.2:1 (range, 0.67:1-6.70:1). Twenty-six children experienced 29 (59%) surgical complications: portacaval shunt thrombosis (n = 2, none alive); graft duodenal stump leakage (n = 3, 2 alive); spontaneous bowel perforation(n = 6, 2 alive); sub-acute bowel obstruction (n = 6, all alive); abdominal compartment syndrome ([ACS], n = 4, 2 alive); pancreatic leak (n = 3, 2 alive); biliary complications (n = 22, 17 alive ) failed staged abdominal closure with wound sepsis requiring skin grafting into the bowel (n = 1, alive), wound dehiscence (n = 1, alive), anastomotic leak (n = 1, alive) and intra-abdominal bleeding (n = 1,alive), primary nonfunction (n = 1, 1 died). Following the complications of ACS in children with primary abdominal closure and graft duodenal stump leaks in 2004, we modified our strategies in 2005 to include staged abdominal closure with recipient to donor weight mismatch, and preservation of the gastroduodenal artery during donor organ procurement in addition to pre transplant abdominal tissue expansion. Fifteen children with recipient and donor weight mismatch subsequently required staged closure of the abdomen and none of them developed ACS. Twelve children had gastroduodenal artery preserved and none developed graft duodenal stump leaks. Twenty-four of the 46 (52%) are alive 6 months to 10 years post transplant. Conclusion: Evolving strategies may avoid or reduce surgical complications commonly seen after intestinal transplantation and thus contribute to an improved outcome.

Original languageEnglish
Pages (from-to)1473-1478
Number of pages6
JournalJournal of Pediatric Surgery
Volume45
Issue number7
DOIs
Publication statusPublished - 2010

Fingerprint

Transplantation
Transplants
Intra-Abdominal Hypertension
Tissue Donors
Arteries
Weights and Measures
Abdominal Wound Closure Techniques
Tissue Expansion Devices
Tissue Expansion
Surgical Portacaval Shunt
Anastomotic Leak
Skin Transplantation
Tissue and Organ Procurement
Liver Transplantation
Abdomen
Medical Records
Sepsis
Thrombosis
Hemorrhage
Morbidity

Keywords

  • Abdominal compartment syndrome
  • Intestinal obstruction
  • Intestinal perforation
  • Intestinal transplantation
  • Small bowel transplantation
  • Staged abdominal closure
  • Vascular thromboses
  • Wound dehiscence

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Gupte, G. L., Haghighi, K. S., Sharif, K., Mayer, D. A., Beath, S. V., Kelly, D. A., ... Millar, A. J. (2010). Surgical complications after intestinal transplantation in infants and children-UK experience. Journal of Pediatric Surgery, 45(7), 1473-1478. https://doi.org/10.1016/j.jpedsurg.2009.08.026

Surgical complications after intestinal transplantation in infants and children-UK experience. / Gupte, Girish L.; Haghighi, Koroush S.; Sharif, Khalid; Mayer, David A.; Beath, Susan V.; Kelly, Deirdre A.; Buckels, John; De Goyet, Jean Deville; Mirza, Darius F.; Millar, Alastair J.

In: Journal of Pediatric Surgery, Vol. 45, No. 7, 2010, p. 1473-1478.

Research output: Contribution to journalArticle

Gupte, GL, Haghighi, KS, Sharif, K, Mayer, DA, Beath, SV, Kelly, DA, Buckels, J, De Goyet, JD, Mirza, DF & Millar, AJ 2010, 'Surgical complications after intestinal transplantation in infants and children-UK experience', Journal of Pediatric Surgery, vol. 45, no. 7, pp. 1473-1478. https://doi.org/10.1016/j.jpedsurg.2009.08.026
Gupte, Girish L. ; Haghighi, Koroush S. ; Sharif, Khalid ; Mayer, David A. ; Beath, Susan V. ; Kelly, Deirdre A. ; Buckels, John ; De Goyet, Jean Deville ; Mirza, Darius F. ; Millar, Alastair J. / Surgical complications after intestinal transplantation in infants and children-UK experience. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 7. pp. 1473-1478.
@article{614e60927cb94507859720d35a0b9979,
title = "Surgical complications after intestinal transplantation in infants and children-UK experience",
abstract = "Surgical complications have a significant impact on morbidity and mortality following intestinal transplantation (ITx). Birmingham Children's Hospital commenced intestinal transplantation in 1993 and the following surgical strategies evolved: (a) pretransplant abdominal tissue expanders, 1998; (b) combined en-bloc reduced liver and intestinal transplantation (CRLITx), 1998; (c) staged abdominal closure, 2001; (d) preservation of graft duodenal artery, 2005. Aim: An internal audit was performed to document the surgical complications after ITx and to evaluate strategies in the management and prevention of complications. Methods: A retrospective analysis of the medical records from January 1993 to June 2007 was conducted to identify surgical complications, evaluate management strategies, and report outcome following ITx. Results: Forty-six children underwent 49 ITx (9 isolated intestinal, 39 combined liver and intestinal [CLITx], and 1 multivisceral transplant). Twenty three children had CRLITx since 1998, although there were none before 1997. The median donor: recipient weight ratio in CLITx was 2.2:1 (range, 0.67:1-6.70:1). Twenty-six children experienced 29 (59{\%}) surgical complications: portacaval shunt thrombosis (n = 2, none alive); graft duodenal stump leakage (n = 3, 2 alive); spontaneous bowel perforation(n = 6, 2 alive); sub-acute bowel obstruction (n = 6, all alive); abdominal compartment syndrome ([ACS], n = 4, 2 alive); pancreatic leak (n = 3, 2 alive); biliary complications (n = 22, 17 alive ) failed staged abdominal closure with wound sepsis requiring skin grafting into the bowel (n = 1, alive), wound dehiscence (n = 1, alive), anastomotic leak (n = 1, alive) and intra-abdominal bleeding (n = 1,alive), primary nonfunction (n = 1, 1 died). Following the complications of ACS in children with primary abdominal closure and graft duodenal stump leaks in 2004, we modified our strategies in 2005 to include staged abdominal closure with recipient to donor weight mismatch, and preservation of the gastroduodenal artery during donor organ procurement in addition to pre transplant abdominal tissue expansion. Fifteen children with recipient and donor weight mismatch subsequently required staged closure of the abdomen and none of them developed ACS. Twelve children had gastroduodenal artery preserved and none developed graft duodenal stump leaks. Twenty-four of the 46 (52{\%}) are alive 6 months to 10 years post transplant. Conclusion: Evolving strategies may avoid or reduce surgical complications commonly seen after intestinal transplantation and thus contribute to an improved outcome.",
keywords = "Abdominal compartment syndrome, Intestinal obstruction, Intestinal perforation, Intestinal transplantation, Small bowel transplantation, Staged abdominal closure, Vascular thromboses, Wound dehiscence",
author = "Gupte, {Girish L.} and Haghighi, {Koroush S.} and Khalid Sharif and Mayer, {David A.} and Beath, {Susan V.} and Kelly, {Deirdre A.} and John Buckels and {De Goyet}, {Jean Deville} and Mirza, {Darius F.} and Millar, {Alastair J.}",
year = "2010",
doi = "10.1016/j.jpedsurg.2009.08.026",
language = "English",
volume = "45",
pages = "1473--1478",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Surgical complications after intestinal transplantation in infants and children-UK experience

AU - Gupte, Girish L.

AU - Haghighi, Koroush S.

AU - Sharif, Khalid

AU - Mayer, David A.

AU - Beath, Susan V.

AU - Kelly, Deirdre A.

AU - Buckels, John

AU - De Goyet, Jean Deville

AU - Mirza, Darius F.

AU - Millar, Alastair J.

PY - 2010

Y1 - 2010

N2 - Surgical complications have a significant impact on morbidity and mortality following intestinal transplantation (ITx). Birmingham Children's Hospital commenced intestinal transplantation in 1993 and the following surgical strategies evolved: (a) pretransplant abdominal tissue expanders, 1998; (b) combined en-bloc reduced liver and intestinal transplantation (CRLITx), 1998; (c) staged abdominal closure, 2001; (d) preservation of graft duodenal artery, 2005. Aim: An internal audit was performed to document the surgical complications after ITx and to evaluate strategies in the management and prevention of complications. Methods: A retrospective analysis of the medical records from January 1993 to June 2007 was conducted to identify surgical complications, evaluate management strategies, and report outcome following ITx. Results: Forty-six children underwent 49 ITx (9 isolated intestinal, 39 combined liver and intestinal [CLITx], and 1 multivisceral transplant). Twenty three children had CRLITx since 1998, although there were none before 1997. The median donor: recipient weight ratio in CLITx was 2.2:1 (range, 0.67:1-6.70:1). Twenty-six children experienced 29 (59%) surgical complications: portacaval shunt thrombosis (n = 2, none alive); graft duodenal stump leakage (n = 3, 2 alive); spontaneous bowel perforation(n = 6, 2 alive); sub-acute bowel obstruction (n = 6, all alive); abdominal compartment syndrome ([ACS], n = 4, 2 alive); pancreatic leak (n = 3, 2 alive); biliary complications (n = 22, 17 alive ) failed staged abdominal closure with wound sepsis requiring skin grafting into the bowel (n = 1, alive), wound dehiscence (n = 1, alive), anastomotic leak (n = 1, alive) and intra-abdominal bleeding (n = 1,alive), primary nonfunction (n = 1, 1 died). Following the complications of ACS in children with primary abdominal closure and graft duodenal stump leaks in 2004, we modified our strategies in 2005 to include staged abdominal closure with recipient to donor weight mismatch, and preservation of the gastroduodenal artery during donor organ procurement in addition to pre transplant abdominal tissue expansion. Fifteen children with recipient and donor weight mismatch subsequently required staged closure of the abdomen and none of them developed ACS. Twelve children had gastroduodenal artery preserved and none developed graft duodenal stump leaks. Twenty-four of the 46 (52%) are alive 6 months to 10 years post transplant. Conclusion: Evolving strategies may avoid or reduce surgical complications commonly seen after intestinal transplantation and thus contribute to an improved outcome.

AB - Surgical complications have a significant impact on morbidity and mortality following intestinal transplantation (ITx). Birmingham Children's Hospital commenced intestinal transplantation in 1993 and the following surgical strategies evolved: (a) pretransplant abdominal tissue expanders, 1998; (b) combined en-bloc reduced liver and intestinal transplantation (CRLITx), 1998; (c) staged abdominal closure, 2001; (d) preservation of graft duodenal artery, 2005. Aim: An internal audit was performed to document the surgical complications after ITx and to evaluate strategies in the management and prevention of complications. Methods: A retrospective analysis of the medical records from January 1993 to June 2007 was conducted to identify surgical complications, evaluate management strategies, and report outcome following ITx. Results: Forty-six children underwent 49 ITx (9 isolated intestinal, 39 combined liver and intestinal [CLITx], and 1 multivisceral transplant). Twenty three children had CRLITx since 1998, although there were none before 1997. The median donor: recipient weight ratio in CLITx was 2.2:1 (range, 0.67:1-6.70:1). Twenty-six children experienced 29 (59%) surgical complications: portacaval shunt thrombosis (n = 2, none alive); graft duodenal stump leakage (n = 3, 2 alive); spontaneous bowel perforation(n = 6, 2 alive); sub-acute bowel obstruction (n = 6, all alive); abdominal compartment syndrome ([ACS], n = 4, 2 alive); pancreatic leak (n = 3, 2 alive); biliary complications (n = 22, 17 alive ) failed staged abdominal closure with wound sepsis requiring skin grafting into the bowel (n = 1, alive), wound dehiscence (n = 1, alive), anastomotic leak (n = 1, alive) and intra-abdominal bleeding (n = 1,alive), primary nonfunction (n = 1, 1 died). Following the complications of ACS in children with primary abdominal closure and graft duodenal stump leaks in 2004, we modified our strategies in 2005 to include staged abdominal closure with recipient to donor weight mismatch, and preservation of the gastroduodenal artery during donor organ procurement in addition to pre transplant abdominal tissue expansion. Fifteen children with recipient and donor weight mismatch subsequently required staged closure of the abdomen and none of them developed ACS. Twelve children had gastroduodenal artery preserved and none developed graft duodenal stump leaks. Twenty-four of the 46 (52%) are alive 6 months to 10 years post transplant. Conclusion: Evolving strategies may avoid or reduce surgical complications commonly seen after intestinal transplantation and thus contribute to an improved outcome.

KW - Abdominal compartment syndrome

KW - Intestinal obstruction

KW - Intestinal perforation

KW - Intestinal transplantation

KW - Small bowel transplantation

KW - Staged abdominal closure

KW - Vascular thromboses

KW - Wound dehiscence

UR - http://www.scopus.com/inward/record.url?scp=77955622220&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955622220&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2009.08.026

DO - 10.1016/j.jpedsurg.2009.08.026

M3 - Article

C2 - 20638527

AN - SCOPUS:77955622220

VL - 45

SP - 1473

EP - 1478

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 7

ER -