Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada.
New Zealand National Intestinal Failure and Rehabilitation Service (NZ-NIFRS), Starship Child Health, Auckland, New Zealand.
Am J Transplant. 2022 Nov;22(11):2608-2615. doi: 10.1111/ajt.17150. Epub 2022 Aug 1.
Deciding which patients would benefit from intestinal transplantation (IT) remains an ethical/clinical dilemma. New criteria* were proposed in 2015: ≥2 intensive care unit (ICU) admissions, loss of ≥3 central venous catheter (CVC) sites, and persistently elevated conjugated bilirubin (CB ≥ 75 μmol/L) despite 6 weeks of lipid modification strategies. We performed a retrospective, international, multicenter validation study of 443 children (61% male, median gestational age 34 weeks [IQR 29-37]), diagnosed with IF between 2010 and 2015. Primary outcome measure was death or IT. Sensitivity, specificity, NPV, PPV, and probability of death/transplant (OR, 95% confidence intervals) were calculated for each criterion. Median age at IF diagnosis was 0.1 years (IQR 0.03-0.14) with median follow-up of 3.8 years (IQR 2.3-5.3). Forty of 443 (9%) patients died, 53 of 443 (12%) were transplanted; 11 died posttransplant. The validated criteria had a high predictive value of death/IT; ≥2 ICU admissions (p < .0001, OR 10.2, 95% CI 4.0-25.6), persistent CB ≥ 75 μmol/L (p < .0001, OR 8.2, 95% CI 4.8-13.9). and loss of ≥3 CVC sites (p = .0003, OR 5.7, 95% CI 2.2-14.7). This large, multicenter, international study in a contemporary cohort confirms the validity of the Toronto criteria. These validated criteria should guide listing decisions in pediatric IT.
决定哪些患者将受益于肠移植（IT）仍然是一个伦理/临床难题。新的标准*于 2015 年提出：≥2 次重症监护病房（ICU）入院，≥3 个中心静脉导管（CVC）丢失，以及尽管进行了 6 周的脂质修饰策略，但结合胆红素（CB≥75μmol/L）持续升高。我们对 2010 年至 2015 年期间被诊断为 IF 的 443 名儿童（61%为男性，中位胎龄为 34 周[IQR 29-37]）进行了回顾性、国际、多中心验证研究。主要结局测量是死亡或 IT。为每个标准计算了敏感性、特异性、NPV、PPV 和死亡/移植的概率（OR，95%置信区间）。IF 诊断时的中位年龄为 0.1 岁（IQR 0.03-0.14），中位随访时间为 3.8 年（IQR 2.3-5.3）。443 名患者中有 40 名（9%）死亡，443 名中有 53 名（12%）接受了移植；11 名在移植后死亡。验证标准对死亡/IT 有很高的预测价值；≥2 次 ICU 入院（p<0.0001，OR 10.2，95%CI 4.0-25.6），持续 CB≥75μmol/L（p<0.0001，OR 8.2，95%CI 4.8-13.9）和≥3 个 CVC 丢失（p=0.0003，OR 5.7，95%CI 2.2-14.7）。这项大型、多中心、国际研究在当代队列中证实了多伦多标准的有效性。这些验证标准应指导儿科 IT 的列表决策。
