Intestinal Donors in Early Infancy: Are Immune-mediated Complications More Problematic?

Background: Small children awaiting intestinal transplantation are disadvantaged because of a lack of size-compatible donors. To achieve suitable access to transplantation, using intestinal grafts from very young donors is an option. However, there is a lack of literature describing the posttransplant immunological complications associated with these grafts. Our aim was to report the outcome of intestine-containing grafts from very young donors (6 mo and younger). Methods: A single-center retrospective study of all children who received an intestine-containing allograft between January 1993 and December 2020. To investigate the effect of donor age, the participants were separated into 3 groups. These comprised early infancy (EI, donors 6 mo and younger), late infancy (LI, 7-12 mo), and an early childhood (EC, 13-36 mo). The primary outcome was clinically significant immunological complications, defined as severe rejection and/or graft versus host disease. Results: During the study period, 105 pediatric intestinal transplants were performed and 35 were from donors aged 36 mo and younger. The EI, LI, and EC donor groups comprised 5, 9, and 21 patients, respectively. The indications for transplant, recipient age (in months) (EI: 17 [15-20], LI: 18 [11-30], EC: 24 [15-47]), and maintenance immunosuppression were similar between groups. Significant immunological complications occurred more frequently in the EI group (EI: 4/5 [80%], LI: 5/9 [56%] EC: 7/21 [33%], P = 0.134), and 3 of 5 of the recipients died as a direct result of these complications. Conclusions: The findings suggest that immunological complications are more frequent with grafts from donors within the first 6 mo of life and caution should be applied with their use.