Transplantation Offers Improved Chances of Long-Term Survival and Quality of Life

Pediatric intestinal transplantation has gone from a procedure many considered prohibitive only a decade ago to one that today offers children greatly improved chances of long-term survival and a quality of life that includes school, play, friends and other joys of childhood.

Many of the advances in surgical technique, immunosuppression management and post-operative care that made such progress possible were developed by doctors at Children’s Hospital of Pittsburgh, which continues to apply its extensive research capabilities and clinical experience to the pursuit of new ways to improve chances of young patients living full and healthy lives.

Early in 2003, surgeons at Children’s Hospital, the nation’s most active pediatric transplant center, performed their 100th intestinal transplant on an 8-year-old boy with short-gut syndrome. Within three months, he was an outpatient. Thanks to advances in immunosuppression pioneered at the hospital, he did not require steroids. Not long before, steroids had been a necessary and often unpleasant part of the post-transplant treatment to prevent the body from rejecting a donor organ.

The timeliness of his discharge and the opportunity for him to recover without steroids underscore the remarkable gains made during the last 13 years and the critical role Children’s Hospital of Pittsburgh plays in the evolution of intestinal transplantation.

Children’s Hospital has a long history of breaking new ground in the management of immunosuppression drugs used to prevent the body from attacking and destroying a transplanted organ. Children’s began performing intestinal transplants in 1990 using Prograf (tacrolimus) as a primary immunosuppressive drug in combination with steroids. By 2002, doctors had developed a new protocol with colleagues at UPMC Presbyterian that allows them to reduce the required dosage of Prograf and eliminate the use of steroids in post-operative treatment. Early outcomes include a survival rate of 100 percent, shorter hospital stays and the prognosis of an easier recovery for most patients.

Other important advances pioneered at Children’s include new tools that allow doctors to detect early and preemptively treat infections, such as cytomegalovirus (CMV) and Epstein-Barr Virus (EBV), which can cause significant post-transplant complications.

Improved surgical techniques developed at Children’s Hospital of Pittsburgh also are helping to ease the critical shortage of donor intestines. Surgeons now are able to successfully reduce an adult intestine to a fraction of its normal size so that it can be implanted in a child, even an infant, if necessary. Soon, they also expect to begin taking both a section of the liver and a section of an intestine from a living-related donor and implant both into a sick child.

The most important outcomes of such advances are that more sick children stand a better chance of recovering and living a quality of life few thought possible a decade ago. In fact, 73 percent of Children’s pediatric intestinal patients are able to take in all of their calories by mouth within three years of their transplant, and more than 80 percent of school-age patients return to school by then.

Advances Made at Children’s Hospital Moved Intestinal Transplants Forward

Advances in Medicine and Treatment Improve Life After Transplantation