Patrones y resultados del cambio de anticoagulantes orales directos en la fibrilación auricular no valvular: experiencia en la práctica clínica en España / Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain

Objetivos El objetivo consistía en evaluar un programa de gestión de anticoagulantes orales directos (ACOD) en pacientes con fibrilación auricular no valvular (FANV) según sus perfiles, idoneidad de la dosis, patrones de cambio de tratamiento, efectividad y seguridad Se trató de un estudio observacional, prospectivo y longitudinal en una cohorte de pacientes atendidos en la práctica clínica cotidiana en un hospital regional español con un plan de seguimiento de 3 años para pacientes que iniciaron el tratamiento con dabigatrán, rivaroxabán o apixabán entre enero de 2012 y diciembre de 2016. Métodos Se analizaron 490 episodios de tratamiento (apixabán 2,5mg, 9,4%; apixabán 5mg, 21,4%; dabigatrán 75mg, 0,6%; dabigatrán 110mg, 12,4%; dabigatrán 150mg, 19,8%; rivaroxabán 15mg, 17,8%; rivaroxabán 20mg, 18,6%) en 445 pacientes. En el 13,6% de los pacientes tratados con dabigatrán, el 9,7% de los tratados con rivaroxabán y el 3,9% de los tratados con apixabán se cambió a otros ACOD o se modificó la dosis. Resultados El ACOD al que se cambió con mayor frecuencia fue el apixabán. Los motivos más frecuentes para cambiar de tratamiento fueron toxicidad (23,8%), hemorragia (21,4%) y deterioro renal (16,7%). En el 23,8% de los episodios se constató una inadecuación de la dosis. Las tasas de ictus y accidentes isquémicos transitorios (AIT) fueron de 1,64 y 0,54 eventos/100 años/paciente, respectivamente, mientras que las de hemorragias importantes, no importantes, pero clínicamente relevantes (NICR) e intracraneales fueron de 2,4, 5 y 0,5 eventos/100 años/paciente, respectivamente. Las hemorragias digestivas y genitourinarias fueron el tipo más frecuente de eventos hemorrágicos. En el análisis multifactorial, el ictus previo y la edad fueron factores predictivos independientes de ictus/AIT. El uso concomitante de antiagregantes plaquetarios, el sexo masculino y la edad fueron factores predictivos independientes de eventos hemorrágicos (AU)

Aims The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between Jan/2012 and Dec/2016. Methods We analyzed 490 episodes of treatment (apixaban 2.5, 9.4%; apixaban 5, 21.4%; dabigatran 75, 0.6%; dabigatran 110, 12.4%; dabigatran 150, 19.8%; rivaroxaban 15, 17.8% and rivaroxaban 20, 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. Results Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. Conclusion This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profil (AU)

Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular / Findings in brainstem auditory evoked potentials in patients under 2 years of age with a history of intraventricular haemorrhage

Introducción: Existen pocos estudios que describan los resultados de la evaluación de la vía auditiva en pacientes con antecedente de hemorragia intraventricular (HIV) durante los primeros años de vida. La hipoacusia puede presentarse desde los grados iniciales de la HIV. Los potenciales evocados auditivos del tallo cerebral (PEATC) son una herramienta útil para diagnosticar alteraciones de la vía auditiva en la infancia temprana. El objetivo del presente estudio fue describir los hallazgos en los PEATC en pacientes menores de 2 años con antecedente de HIV. Pacientes y métodos: Es un estudio observacional retrospectivo realizado en pacientes menores de 2 años con antecedente de HIV enviados a nuestro hospital para la realización de PEATC en un período de tres años. Se excluyó a pacientes con síndromes genéticos asociados a hipoacusia. A través de los PEATC se evaluó la presencia o la ausencia de respuesta bioeléctrica y latencias de las ondas I, III y V, así como de los intervalos I-III, III-V y I-V, además de su morfología, amplitud, sincronía y la replicabilidad. Se realizó un análisis de tipo descriptivo con cálculo de frecuencias y porcentajes. Resultados: Se incluyó a un total de 122 pacientes. El 51% de ellos tenía antecedente de HIV de grado I; el 42%, de grado II; y el 7%, de grados III o IV. La respuesta bioeléctrica se obtuvo en 243 vías auditivas (99,6%). La morfología se encontró alterada en el 6,2% de las vías auditivas, mientras que las amplitudes estuvieron disminuidas en el 2,5% de las evaluadas. Las latencias para las ondas I y III se encontraron prolongadas en el 2%, y, para la onda V, en el 3,6% de los pacientes. El umbral auditivo fue normal en el 64,8%, y el 35,2% de los casos presentó hipoacusia. Conclusiones: La prevalencia de la hipoacusia fue alta en la muestra analizada. Se recomienda realizar el seguimiento mediante PEATC de forma sistemática con la finalidad de detectar y atender oportunamente problemas...(AU)

Introduction: There are few studies that describe the results of auditory pathway assessment in patients with a history of intraventricular haemorrhage (IVH) during the early years of life. Hypoacusis can occur from the earliest stages of IVH. Brainstem auditory evoked potentials (BAEPs) are a useful tool for diagnosing auditory pathway disorders in early childhood. The aim of the present study was to describe the BAEPs findings in patients under 2 years of age with a history of IVH. Patients and methods: We conducted a retrospective observational study in patients under 2 years of age with a history of IVH referred to our hospital for BAEPs over a period of three years. Patients with genetic syndromes associated with hypoacusis were excluded. BAEPs were used to evaluate the presence or absence of any bioelectrical response and latencies of waves I, III and V, as well as of the intervals I-III, III-V and I-V, and also their morphology, amplitude, synchrony and reproducibility. A descriptive analysis was carried out with the calculation of frequencies and percentages. Results: A total of 122 patients were included. Fifty-one per cent of them had a history of Grade I IVH; 42%, Grade II; and 7%, Grades III or IV. A bioelectrical response was obtained in 243 auditory pathways (99.6%). The morphology was found to be altered in 6.2% of the auditory pathways, while amplitudes were decreased in 2.5% of those tested. Latencies for waves I and III were found to be prolonged in 2% and for wave V in 3.6% of patients. The hearing threshold was normal in 64.8%, and 35.2% of cases presented hypoacusis.Conclusions: The prevalence of hypoacusis was high in the sample analysed. Systematic follow-up using BAEPs is recommended in order to detect and treat problems in the auditory pathway in patients with IVH in a timely manner.(AU)

[Findings in brainstem auditory evoked potentials in patients under 2 years of age with a history of intraventricular haemorrhage]. / Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular.

INTRODUCTION: There are few studies that describe the results of auditory pathway assessment in patients with a history of intraventricular haemorrhage (IVH) during the early years of life. Hypoacusis can occur from the earliest stages of IVH. Brainstem auditory evoked potentials (BAEPs) are a useful tool for diagnosing auditory pathway disorders in early childhood. The aim of the present study was to describe the BAEPs findings in patients under 2 years of age with a history of IVH. PATIENTS AND METHODS: We conducted a retrospective observational study in patients under 2 years of age with a history of IVH referred to our hospital for BAEPs over a period of three years. Patients with genetic syndromes associated with hypoacusis were excluded. BAEPs were used to evaluate the presence or absence of any bioelectrical response and latencies of waves I, III and V, as well as of the intervals I-III, III-V and I-V, and also their morphology, amplitude, synchrony and reproducibility. A descriptive analysis was carried out with the calculation of frequencies and percentages. RESULTS: A total of 122 patients were included. Fifty-one per cent of them had a history of Grade I IVH; 42%, Grade II; and 7%, Grades III or IV. A bioelectrical response was obtained in 243 auditory pathways (99.6%). The morphology was found to be altered in 6.2% of the auditory pathways, while amplitudes were decreased in 2.5% of those tested. Latencies for waves I and III were found to be prolonged in 2% and for wave V in 3.6% of patients. The hearing threshold was normal in 64.8%, and 35.2% of cases presented hypoacusis. CONCLUSIONS: The prevalence of hypoacusis was high in the sample analysed. Systematic follow-up using BAEPs is recommended in order to detect and treat problems in the auditory pathway in patients with IVH in a timely manner.

TITLE: Hallazgos en los potenciales evocados auditivos del tallo cerebral en pacientes menores de 2 años con antecedente de hemorragia intraventricular.Introducción. Existen pocos estudios que describan los resultados de la evaluación de la vía auditiva en pacientes con antecedente de hemorragia intraventricular (HIV) durante los primeros años de vida. La hipoacusia puede presentarse desde los grados iniciales de la HIV. Los potenciales evocados auditivos del tallo cerebral (PEATC) son una herramienta útil para diagnosticar alteraciones de la vía auditiva en la infancia temprana. El objetivo del presente estudio fue describir los hallazgos en los PEATC en pacientes menores de 2 años con antecedente de HIV. Pacientes y métodos. Es un estudio observacional retrospectivo realizado en pacientes menores de 2 años con antecedente de HIV enviados a nuestro hospital para la realización de PEATC en un período de tres años. Se excluyó a pacientes con síndromes genéticos asociados a hipoacusia. A través de los PEATC se evaluó la presencia o la ausencia de respuesta bioeléctrica y latencias de las ondas I, III y V, así como de los intervalos I-III, III-V y I-V, además de su morfología, amplitud, sincronía y la replicabilidad. Se realizó un análisis de tipo descriptivo con cálculo de frecuencias y porcentajes. Resultados. Se incluyó a un total de 122 pacientes. El 51% de ellos tenía antecedente de HIV de grado I; el 42%, de grado II; y el 7%, de grados III o IV. La respuesta bioeléctrica se obtuvo en 243 vías auditivas (99,6%). La morfología se encontró alterada en el 6,2% de las vías auditivas, mientras que las amplitudes estuvieron disminuidas en el 2,5% de las evaluadas. Las latencias para las ondas I y III se encontraron prolongadas en el 2%, y, para la onda V, en el 3,6% de los pacientes. El umbral auditivo fue normal en el 64,8%, y el 35,2% de los casos presentó hipoacusia. Conclusiones. La prevalencia de la hipoacusia fue alta en la muestra analizada. Se recomienda realizar el seguimiento mediante PEATC de forma sistemática con la finalidad de detectar y atender oportunamente problemas de la vía auditiva en pacientes con HIV.

Patterns and outcomes of switching direct oral anticoagulants in non-valvular atrial fibrillation: A real-world experience from Spain.

AIMS: The aim is to evaluate a management program for direct oral anticoagulants (DOACs) in non-valvular atrial fibrillation (NVAF) patients according to their profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal prospective study in a cohort of patients attended in daily clinical practice in a regional hospital in Spain with 3-year a follow-up plan for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. METHODS: We analyzed 490 episodes of treatment (apixaban 2.5 9.4%, apixaban 5 21.4%, dabigatran 75 0.6%, dabigatran 110 12,4%, dabigatran 150 19.8%, rivaroxaban 15 17.8% and rivaroxaban 20 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban switched to other DOACs or changed dosing. RESULTS: Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding were 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke and age were independent predictors of stroke/TIA. Concurrent platelet inhibitors, male gender and age were independent predictors of BE. CONCLUSION: This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile.

Pandemia y atencion ambulatoria pediatrica de alta complejidad en un hospital publico. Experiencia de un modelo de atención con uso de telemedicina en niños/as con nutrición parenteral domiciliaria / Pandemic and highly complex pediatric outpatient care in a public hospital. Experience of a care model with the use of telemedicine in children with home parenteral nutrition

Introducción: Los pacientes que reciben nutrición parenteral domiciliaria (NPD) en seguimiento desde el Hospital requieren un monitoreo que debió modificarse por la pandemia por SARS-CoV-2. Objetivo: Valorar la utilización y el impacto en los resultados, de estrategias alternativas a la atención presencial de pacientes con NPD, empleando telemedicina, durante el inicio de la pandemia por SARS-CoV-2, comparándolas con las prácticas habituales previas. Materiales y métodos: Estudio analítico descriptivo retrospectivo que analizó el monitoreo, la evolución y las complicaciones de pacientes con NPD asistidos en el Hospital en el período previo a la pandemia (1/4/2019 y 31/3/2019) y durante su primer año (1/4/2020 a 31/3/2021), basado en la revisión de historias clínicas y bases de datos de complicaciones. Resultados: Las características demográficas, diagnósticos, procedencia y provisión de la NPD fueron similares en los dos períodos. Durante el período de la pandemia se redujeron en forma significativa el número de controles presenciales y aumentaron los realizados por telemedicina en forma sincrónica (con una modalidad pautada previamente), y los controles por profesionales locales. La participación de los cuidadores en los procedimientos de administración de la NPD aumentó en pandemia. Las tasas de complicaciones, re-internaciones, el número de inicios y suspensiones de tratamiento fueron similares en ambos períodos. Conclusiones: En pandemia fue posible implementar y monitorizar la NPD utilizando telemedicina sin observar afectación significativa de la evolución, las complicaciones de la enfermedad y del tratamiento. El seguimiento mediante telemedicina sincrónica resultó útil y se incorporará como una herramienta más al monitoreo habitual sin reemplazarlo

Introduction: Patients receiving home parenteral nutrition (HPN) under follow-up from the Hospital require monitoring that had to be modified due to the SARSCoV-2 pandemic. Objective: To assess the use and the impact on the results of other care strategies for patients with HPN, using telemedicine, during the beginning of the SARS CoV2 pandemic, compared with previous usual practices.Materials and methods: Retrospective descriptive analytical study that analyzed the monitoring, evolution and complications of patients with HPN assisted in the Hospital, in the period before pandemic ( 4/1/2019 to 3/31/2020) and during the first year of SARS CoV-2 pandemic (4/1/2020 to 3/31/2021), according to data obtained from medical records and databases. Results: demographic characteristics, diagnoses, place of residence and HPN provision were similar in both periods. During the pandemic period, the number of face-to-face controls were significantly reduced and those carried out by telemedicine synchronously, and by local professionals increased. The participation of caregivers in the administration procedures of the HPN increased in the pandemic period. The rates of complications, readmissions, number of initiations and suspensions of home treatment were similar in both periods. Conclusions: It was possible to implement and monitor HPN during pandemic. The evolution and complications of the disease and treatment were not significantly affected. Synchronous telemedicine follow-up was successfully useful and will be incorporated as another tool to regular monitoring

Estudio experimental aleatorizado para la evaluación de la efectividaddel proyecto Flebitis Zero en Navarra / Randomized experimental study to evaluate the effectiveness of the Flebitis Zero project in Navarre

Fundamento:La flebitis es una de las complicaciones más frecuentes en los catéteres venosos periféricos (CVP). El objetivo fue comparar la frecuencia de flebitis previa y tras la implantación del proyecto Flebitis Zero, para conocer la efectividad del mismo y los factores relacionados con dicha complicación.Material y métodos:Estudio aleatorizado de comparación pre-post intervención (proyecto Flebitis Zero) realizado en el Hospital Universitario de Navarra (Pamplona, España) entre 2015 y 2019. La intervención consistió en la formación del personal y en la implementación de medidas que permitan disminuir la incidencia de complicaciones de los catéteres venosos periféricos. El grupo control (GC) se seleccionó antes de la puesta en marcha del proyecto Flebitis Zero, y el grupo intervención (GI) a lo largo de los cinco años posteriores.Resultados:Se incluyeron 656 pacientes, 96 en el GC (14,6%) y 569 en el GI. En el GI se observó menor frecuencia de complicaciones (49 vs 37,1%; p<0,001), especialmente salida accidental del dispositivo (18,8 vs 8,1%), y de flebitis (13,5 vs 11,8%). La intervención y el uso de apósitos totalmente reforzados se asociaron a la no aparición de flebitis La instauración del proyecto Flebitis Zero fue un factor protector de flebitis (OR = 0,78; IC95%: 0,42-0,86; p = 0,042).Conclusiones:La implantación de las medidas trabajadas con el proyecto Flebitis Zero se asociaron a una reducción significativa de las complicaciones asociadas al uso de los catéteres venosos periféricos; la frecuencia de flebitis disminuyó, pero lejos aún de los niveles recomendados.(AU)

Background: Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication.Methods: Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. Results: The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR= 0.78; IC95%: 0.42-0.86; p= 0.042). Conclusion: The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.(AU)

[Randomized experimental study to evaluate the effectiveness of the Flebitis Zero project in Navarre].

BACKGROUND: Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication. METHODS: Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. RESULTS: The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR = 0.78; IC95%: 0.42-0.86; p = 0.042). CONCLUSION: The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.

Percolation-intercropping strategies to prevent dissemination of phytopathogens on plantations.

Phytophthora is one of the most aggressive and worldwide extended phytopathogens that attack plants and trees. Its effects produce tremendous economical losses in agronomy and forestry since no effective fungicide exists. We propose to combine percolation theory with an intercropping sowing configuration as a non-chemical strategy to minimize the dissemination of the pathogen. In this work, we model a plantation as a square lattice where two types of plants are arranged in alternating columns or diagonals, and Phytophthora zoospores are allowed to propagate to the nearest and next-to-nearest neighboring plants. We determine the percolation threshold for each intercropping configuration as a function of the plant's susceptibilities and the number of inoculated cells at the beginning of the propagation process. The results are presented as phase diagrams where crop densities that prevent the formation of a spanning cluster of susceptible or diseased plants are indicated. The main result is the existence of susceptibility value combinations for which no spanning cluster is formed even if every cell in the plantation is sowed. This finding can be useful in choosing a configuration and density of plants that minimize damages caused by Phytophthora. We illustrate the application of the phase diagrams with the susceptibilities of three plants with a high commercial value.

Site-bond percolation solution to preventing the propagation of Phytophthora zoospores on plantations.

We propose a strategy based on the site-bond percolation to minimize the propagation of Phytophthora zoospores on plantations, consisting in introducing physical barriers between neighboring plants. Two clustering processes are distinguished: (i) one of cells with the presence of the pathogen, detected on soil analysis, and (ii) that of diseased plants, revealed from a visual inspection of the plantation. The former is well described by the standard site-bond percolation. In the latter, the percolation threshold is fitted by a Tsallis distribution when no barriers are introduced. We provide, for both cases, the formulas for the minimal barrier density to prevent the emergence of the spanning cluster. Though this work is focused on a specific pathogen, the model presented here can also be applied to prevent the spreading of other pathogens that disseminate, by other means, from one plant to the neighboring ones. Finally, the application of this strategy to three types of commercially important Mexican chili plants is also shown.

Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.