<p>Title: The use of renal replacement therapy in pediatric small bowel transplantation patients: experience and outcomes from one pediatric intensive care unit.</p><p>Authors: Pineda C1, Zaritsky J2, Venick R3, and Kelly RB1. </p><p>Affiliation: Divisions of Critical Care1, Nephrology2, and Gastroenterology3 – Department of Pediatrics – David Geffen School of Medicine at UCLA and Mattel Children’s Hospital UCLA – Los Angeles, CA, USA </p><p>Background: Several pediatric studies report poor outcomes among orthotopic liver transplantation patients requiring renal replacement therapy (RRT), but the prognosis for pediatric small bowel transplantation (SBT) patients requiring RRT remains unknown. Given the potential severity of illness among SBT patients as well as the significant resources required to provide RRT, a greater understanding of outcomes of pediatric SBT patients receiving RRT is needed.</p><p>Objective: To analyze the outcomes of pediatric SBT patients receiving RRT in the pediatric intensive care unit (PICU).</p><p>Methods: Institutional Review Board-approved retrospective case series from a university-affiliated tertiary care children’s hospital. Inclusion criteria: PICU patients 0-21 years of age receiving RRT with a history of SBT between January 1, 2000-December 31, 2011. Exclusion criteria: Patients receiving RRT before a PICU admission.</p><p>Results: Between January 1, 2000-December 31, 2011 seven SBT patients received RRT (age range: 5-19 years), including intermittent hemodialysis, continuous veno-venous hemodiafiltration and continuous veno-venous hemodialysis. Body surface area of RRT recipients ranged from 0.43-1.09 m2 (mean, 0.75 m2; median 0.72 m2). Four patients (57%) survived to hospital discharge. Among survivors, RRT was started between 4-16 days following SBT (mean, 11.5 days; median 13.0 days) and was required for a total of 1-112 days (mean, 42.8 days; median 29.0 days). Of the four survivors, three (75%) survived to hospital discharge without renal transplantation, and one patient received a renal transplantation. All four survivors were discharged off RRT.</p><p>Discussion: In this small case series, RRT among SBT patients in the PICU appears to be associated with acceptable survival to hospital discharge. Furthermore, freedom from RRT at the time of hospital discharge among survivors supports the use of RRT in this population. In our experience, despite prolonged RRT administration in this population, survival to hospital discharge was still achievable. Future studies with a larger patient cohort are needed to investigate predictors of successful RRT termination in the pediatric SBT population. Contact: Carol Pineda MD, Division of Pediatric Critical Care, Mattel Children’s Hospital UCLA – 10833 Le Conte Avenue, 12-494 MDCC, Los Angeles, CA 90095, Tel: 310-825-9124, Fax: 310-794-6623, E-mail: [email protected]</p>