Improved Strategies, Better Results

Several important changes were made in UPMC Children’s Hospital of Pittsburgh’s approach to intestinal transplantation after 1995. Subsequently, five-year survival rates for small bowel transplant patients have improved to nearly 75 percent. And more than 80 percent of the young patients returned to school within three years following their surgeries.

Early Detection of Cytomegalovirus and Epstein-Barr Virus

One important change was the development of new tools that allow for the early diagnosis of infections, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV), which can cause significant post-transplant complications. For example, detecting CMV before patients get sick and preemptively treating it eliminates the risk of an infection that can invade the bowel lining and lead to pneumonia, hepatitis and other problems.

“Cytomegalovirus was once a major problem,” says George Mazariegos, MD, co-director of Pediatric Transplantation. “Now, we see one case in every 10 transplants, at the most.”

New Immunosuppression Strategies Improved Outcomes

The development of new immunosuppression strategies – a strength of Children’s Hospital of Pittsburgh’s program – continued as doctors explored several approaches to reducing rejection and easing the hardship of recovery for young transplant patients.

New ground in immunosuppression was broken, but not always as planned. For example, when a strategy that added a third drug to the combination of Prograf® and steroids proved less effective than doctors had hoped, they decided to explore a radically different approach: minimal use of drug therapy in preventing organ rejection.

By 2002, doctors at UPMC Children’s Hospital and colleagues at UPMC Presbyterian had developed a strategy to reduce use of immunosuppressive drugs and limit the risk of undesirable side effects, such as a greater risk of infection, while protecting the transplanted intestine from rejection.

Learn more about Steroid-Free Recovery from intestinal transplantation.