Surgical complications in pediatric and adolescent renal transplantation

To report the surgical complications among our pediatric and adolescent renal transplants and to compare these results with other reported series in the literature. A total of 50 pediatric and adolescent renal transplants were included in this study. There were 30 boys and 20 girls with a mean age of 13 years (range 6 - 18 years). 70% of patients received their kidneys from living donors. Two patients underwent renal re-transplantation. Among the 52 transplantations, 17 surgical complications were encountered in 15(30%) patients. The incidence of urological and vascular complications was respectively 13.2% and 18.9%. These complications included vesico-ureteral reflux (9.4%), urinary leakage (3.8%), lymphocele (5.8%), peri-renal hematoma (1.9%), renal artery stenosis (3.7%), and thrombosis of the allograft (7.5%). The patients with vesico-ureteral reflux were treated by antibiotic prophylaxis. In four recipients, thrombosis of the allo-graft with subsequent graft loss occurred. The graft survival rate was 90% in 1 year, 77% in 5 years and 40% in 10 years follow-up. The patient survival rate was 94.4% in 1 year and 84% after 8 years follow-up. We conclude that surgical complications can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication are critical for graft and patient survival

Cephalic Duodenopancreatectomy for Hyperalgic Duodenal Crohn's Disease Fistulized in the Pancreatic Gland

Upper gastrointestinal (GI) tract involvement in adult Crohn's disease (CD) is rare and severe complications unusual. Stenosis has been reported, but gastroduodenal fistulae are seldom detected during surgery and most of the fistulae are cologastric or ileogastric. In complicated gastroduodenal CD, medical treatments are often effective and surgery is only considered in exceptional cases. We here report the unusual case of a 23-year-old patient with upper GI CD presenting a hyperalgic giant ulcer of the bulb fistulized in the pancreatic gland. The failure of steroids and two lines of combined treatment led us to a salvage surgical option. Abdominal exploration showed a plate stomach with an inflammatory bulboduodenal block. Cephalic duodenopancreatectomy and cholecystectomy were performed; histological analysis reported large fissuring pylorus ulceration with micro abscesses reaching the pancreas and the presence of non-caseating granulomas. Six months after the surgery, the patient had stopped antalgic treatment and did not have residual abdominal pain. He had gained 11 kg in weight and had no diarrhea with pancreatic enzymes. To our knowledge, we report the first case of an upper GI and fistulizing CD patient heavily treated with steroids and combined immunosuppressant agents requiring salvage cephalic duodenopancreatectomy

P322 Compared Efficacy of Second-Line Treatments for Ulcerative Colitis After Failure of Vedolizumab in First-Line Treatment: A Retrospective Multicenter Study

Meeting abstract du "19th Congress of ECCO", Stockholm, Suède, 21-24 février, 2024International audienceBackground Vedolizumab is often used as the first-line advanced therapy for patients with moderate to severe ulcerative colitis (UC). There is currently no data reporting the efficacy and safety of second-line treatments after initial vedolizumab failure. The objective of our study was to compare the efficacy of anti-TNF, ustekinumab, and tofacitinib as 2nd line treatment of UC after vedolizumab exposure. Methods We conducted a retrospective multicenter study in 27 French and Belgian centers. All consecutive UC patients treated with vedolizumab between January 2019 and June 2023 as the first line and who received a 2nd line of anti-TNF, ustekinumab or tofacitinib were retrospectively included. The primary outcome was clinical remission at induction (week 14) defined by a clinical partial Mayo score ≤ 2 with no subscore > 1 without investigated treatment withdrawal. Clinical response was defined as a decrease in partial Mayo score of at least 30%. Results Among the 163 patients included, 94 (57.7%) were treated with anti-TNF (infliximab=71 (75.5%), adalimumab=21 (22.3%), and golimumab=2 (2.1%)), 56 (34.4%) with ustekinumab and 13 (7.9%) with tofacitinib. The median duration of the disease prior to second-line initiation was 9.5 months (IQR 16.0-146.0). The median duration of treatment with vedolizumab was 6 months (IQR 3.0-12.0). At week 14, 25/66 (37.9%) patients on infliximab, 7/23 (30.5%) on SQ anti-TNF (adalimumab and golimumab), 25/57 (43.9%) on ustekinumab and 7/13 (53.8%) treated with tofacitinib were in remission (p=0.49, Chi2 test). Response rates were 52.8%, 34.8%, 50.9%, and 53.8%, respectively, for the infliximab, antiTNF SC, ustekinumab, and tofacitinib groups. The survival without treatment discontinuation att 12 months was estimated at 51.6 (95% CI [39.6%-67.2%]) for infliximab, 45.7% (95% CI [28.5%-73.1%]) for SQ anti-TNF, 40.6% (95% CI [27.2%-60.6%]) for ustekinumab and 31.2% (95% CI [12.3%-79.2%]) for tofacitinib (p=0.95, log-rank test). Second-line treatment was discontinued in 41 patients (25.3%) for primary failure, 25 (15.4%) for secondary failure. Colectomy was required in 4 patients (2.5%) during follow-up. Infliximab was discontinued in 12 patients (12.8%) due to adverse reactions, including 6 allergic reactions. Among the 23 patients on SQ anti-TNF (adalimumab and golimumab), 2 required discontinuation (8.7%) due to adverse reactions. One side effect leading to discontinuation occurred with tofacitinib (7.7%) and none with ustekinumab. Conclusion After the failure of vedolizumab as a first-line biologic treatment for UC, the induction efficacy, persistence, and safety of the different second-line treatments seem similar. Current efforts to increase the sample size and strengthen the analysis is ongoing