Impact of Intestinal Rehabilitation Program and Its Innovative Therapies on the Outcome of Intestinal Transplant Candidates

ABSTRACT Objectives: The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal tran...

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Published inJournal of pediatric gastroenterology and nutrition Vol. 61; no. 1; pp. 18 - 23
Main Authors Avitzur, Yaron, Wang, Jenny Y., Silva, Nicole T., Burghardt, Karolina M., DeAngelis, Maria, Grant, David, Ng, Vicky L., Jones, Nicola, Wales, Paul W.
Format Journal Article
LanguageEnglish
Published United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01.07.2015
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Abstract ABSTRACT Objectives: The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list. Methods: A retrospective cohort study of children assessed for IT (n = 84) during a 10‐year period. Comparisons were made among the following 3 time periods: before the establishment of our center's IRP (1999–2002; n = 33), early IRP (2003–2005; n = 18), and late IRP (2006–2009; n = 33). The following endpoints were used: patient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study. Results: The late‐IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005). Conclusions: Treatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
AbstractList OBJECTIVES:The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list. METHODS:A retrospective cohort study of children assessed for IT (n = 84) during a 10-year period. Comparisons were made among the following 3 time periodsbefore the establishment of our centerʼs IRP (1999–2002; n = 33), early IRP (2003–2005; n = 18), and late IRP (2006–2009; n = 33). The following endpoints were usedpatient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study. RESULTS:The late-IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005). CONCLUSIONS:Treatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list. A retrospective cohort study of children assessed for IT (n = 84) during a 10-year period. Comparisons were made among the following 3 time periods: before the establishment of our center's IRP (1999-2002; n = 33), early IRP (2003-2005; n = 18), and late IRP (2006-2009; n = 33). The following endpoints were used: patient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study. The late-IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005). Treatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
ABSTRACT Objectives: The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list. Methods: A retrospective cohort study of children assessed for IT (n = 84) during a 10‐year period. Comparisons were made among the following 3 time periods: before the establishment of our center's IRP (1999–2002; n = 33), early IRP (2003–2005; n = 18), and late IRP (2006–2009; n = 33). The following endpoints were used: patient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study. Results: The late‐IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005). Conclusions: Treatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
OBJECTIVESThe outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess the impact of IRP on the outcome of intestinal transplant (IT) candidates and the transplant waiting list.METHODSA retrospective cohort study of children assessed for IT (n = 84) during a 10-year period. Comparisons were made among the following 3 time periods: before the establishment of our center's IRP (1999-2002; n = 33), early IRP (2003-2005; n = 18), and late IRP (2006-2009; n = 33). The following endpoints were used: patient outcome following IT assessment (not listed, listed and removed from the list, received transplant, died while on the list), patient characteristics at IT assessment, and patient status at the end of the study.RESULTSThe late-IRP era was associated with an increase in patients who were not listed (42% vs 28% at other periods, P = NS) and patients who were removed from the IT waiting list because of clinical improvement (P < 0.0005), and a decrease in those who died before transplant (15% vs >60% at other periods, P < 0.0005). The cause of death shifted from traditional causes such as liver failure or sepsis to other comorbid conditions (P < 0.005). Improved liver function at listing was also observed during late IRP (P < 0.005).CONCLUSIONSTreatment by IRP, coupled with recent advances in the medical management of intestinal failure, is associated with improved survival and outcome of patients waiting for IT, and may lead to overall reduction in the number of IT in the future.
Author Silva, Nicole T.
Ng, Vicky L.
DeAngelis, Maria
Burghardt, Karolina M.
Jones, Nicola
Wales, Paul W.
Wang, Jenny Y.
Grant, David
Avitzur, Yaron
AuthorAffiliation Division of Gastroenterology, Hepatology and Nutrition †Transplant Centre ‡Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children and University of Toronto, Toronto, Canada
AuthorAffiliation_xml – name: Division of Gastroenterology, Hepatology and Nutrition †Transplant Centre ‡Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children and University of Toronto, Toronto, Canada
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  givenname: Jenny Y.
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/25611029$$D View this record in MEDLINE/PubMed
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Copyright 2015 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology
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Snippet ABSTRACT Objectives: The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by...
OBJECTIVES:The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated...
The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal...
OBJECTIVESThe outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated...
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SubjectTerms Child
Child, Preschool
Female
Humans
Infant
Intestinal Diseases - surgery
Intestinal Diseases - therapy
intestinal failure
intestinal rehabilitation
intestinal transplantation
Intestines - pathology
Intestines - surgery
Male
Organ Transplantation
program
Retrospective Studies
Therapies, Investigational
therapy
Waiting Lists
Title Impact of Intestinal Rehabilitation Program and Its Innovative Therapies on the Outcome of Intestinal Transplant Candidates
URI https://onlinelibrary.wiley.com/doi/abs/10.1097%2FMPG.0000000000000735
https://www.ncbi.nlm.nih.gov/pubmed/25611029
https://search.proquest.com/docview/1691595683
Volume 61
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