Introduction: Gastroschisis (Gx) is the leading cause of short gut syndrome in our intestinal rehabilitation population and the principal reason for intestinal transplantation (ITx). We investigated the results after ITx in this group of children and compared them to those with other etiologies.

Methods: A retrospective review of all ITx performed at our center was done. Eighteen ITx were done in 18 children between 2004-2018. Outcome data was collected for both surgical and non-surgical factors, and analyzed. Chi-square and independent t-test were used for statistical analysis. p<0.05 was considered significant. The study was approved by our Institutional Review Board (IRB #2019-2474).

Results: Eighteen patients underwent ITx. The most common diagnosis leading to ITx was Gx (7/18, 39%). Other causes included midgut volvulus (3), necrotizing enterocolitis (2), Hirschsprung’s disease (2), motility disorders (2) and other causes (2). Boys predominated in both groups (4/7 Gx vs. 6/11 in all others, p=0.91). Mean age at listing was similar (3.4±5.1 in Gx vs. 3.1±2.7 years in all others, p=0.70). The mean time on the waitlist prior to ITx was also similar in both groups (1.4±1.5 vs. 0.9±1.2 years, p=0.41). Both groups were transplanted at a similar age (5.3±4.7 vs. 4.0±3.2 years, p=0.5). One of 7 patients in the Gx group underwent multivisceral transplant compared to 2/11 in the all others group (p=0.83). Initial feeds were started later after the transplant in the Gx group (48.9 ±72.9 vs. 18.6±13.4 days, p=0.24) and mean post-operative hospital stay was also longer in the Gx group (112.9±165.5 vs. 78.7±53.9 days, p=0.53). However, a significantly greater proportion of Gx patients (6/7, 86%) were discharged on full enteral feeds compared to the patients in the all other group (4/11, 36%), p=0.04. Overall patient and graft survival in the entire cohort at 1 year was 89% and 83% respectively. 1-year patient survival was similar in either group: Gx 6/7 (86%) vs 10/11 (91%) in all others (p=0.73). 1-year graft survival was also equal in both groups: 5/7 (71%) in the Gx group vs 10/11 (91%) in all others (p=0.28).

Conclusions: Outcomes after pediatric ITx appear satisfactory and similar regardless of the underlying diagnosis and represents a viable alternative to long-term parenteral nutrition. Gastroschisis patients appear to have longer lengths of stay after ITx, but also appear to achieve a more complete recovery in terms of independence from parenteral nutrition.