151: A single-centre experience of ileostomy formation and subsequent reconnection surgery in the context of intestinal transplant in children

Introduction: Ileostomy formation at the time of small bowel transplant (SBT) is common practice and facilitates regular graft surveillance to identify early rejection, without need for ileocolonoscopy. Once the risk of early rejection has decreased, reconnection surgery (RS) is preferable to attain intestinal continuity. We reviewed our centre’s experience of stoma formation in SBT over a 10-year period including the indications and timing of RS. Methods: A retrospective case note analysis of children in the Birmingham Children’s Hospital SBT programme undergoing initial transplant between 2012 and 2022 was performed. Children who had recent SBT (within 12 months) or who died early (within 12 months of transplant) were excluded. We compared baseline characteristics between children who did and didn’t undergo RS and explored individual patient factors and their association with timing of subsequent RS. Results: 25 children underwent either isolated small bowel or multivisceral transplant over this ten-year period. 5 children were excluded (4 due to early mortality and 1 child recently transplanted). Among 20 children included, 14 had short bowel syndrome (SBS) and 3 had microvillous inclusion disease (MVID). Early rejection (within 90 days of transplant) occurred in 9 (45%) children (6 classified as mild histologically). Stoma complications were more common in children with early rejection (55.5%) versus those without (36.4%). At least one stoma complication occurred in 9 (45%) patients and 4 (20%) children required stoma revision (Figure 1). At time of audit, RS had taken place in 12 (60%) children and another 3 are listed for RS. Of 12 children who underwent RS, 7 had SBS and 3 had MVID. Baseline characteristics and pre-transplant morbidity were similar between children undergoing RS and those who didn’t (Table 1). A loopogram was performed prior to RS in all cases where achieving full bowel continuity was intended (not those with colostomy). The mean time between transplant and RS was 563 days (range 96–1577) and mean (SD) admission time for RS was 18 (14.8) days. Reasons for not listing for RS included graft rejection and patient/caregiver choice. Complications post-RS included high stoma output with perianal excoriation and repeat surgery, indicated in two patients (16.7%). Conclusion: Ileostomy formation facilitates monitoring of the small bowel graft post SBT but complications of ileostomy occur in 45% with 20% requiring surgery. Reconnection surgery was achieved in over half of patients. Better understanding stoma complications may facilitate the scheduling of RS earlier in the post-transplant course.