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Published on: August 20, 2007
Long-term results of intestinal transplantation for pseudo-obstruction in children
1Organ Transplantation Program, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA.
Insights
Intestinal transplantation without stomach or colon can offer children with chronic intestinal pseudo-obstruction a good quality of life. This procedure presents unique management challenges but leads to improved outcomes.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Transplantation medicine
Background:
- Chronic intestinal pseudo-obstruction significantly impacts children's quality of life.
- Intestinal transplantation is a complex procedure for end-stage intestinal failure.
Purpose of the Study:
- To evaluate the long-term outcomes of intestinal transplantation in pediatric patients with pseudo-obstruction.
- To assess the efficacy of intestinal transplantation when the stomach and colon are excluded from the allograft.
Main Methods:
- Retrospective case-record review of pediatric patients undergoing intestinal transplantation for pseudo-obstruction.
- Data collection included outpatient charts, databases, and parental surveys for comprehensive follow-up.
Main Results:
- Eight patients underwent 6 small bowel and 3 liver-small bowel transplants between 1993-1999.
- Median follow-up was 40 months; median graft survival was 15 months.
- Five survivors achieved full enteral feeding, with 3 having normal bowel movements and 4 ileostomies closed.
Conclusions:
- Intestinal transplantation excluding stomach and colon can provide a good quality of life for children with chronic intestinal pseudo-obstruction.
- Management of pseudo-obstruction post-transplant requires specialized care due to disease-specific challenges.
Purpose:
The aim of this study was to determine long-term results of intestinal transplantation in children with pseudo-obstruction, particularly when stomach and colon are not part of the allograft.
Methods:
The authors conducted a case-record review of all children who underwent transplantation at our center for a primary diagnosis of pseudo-obstruction. Supplementary information was obtained from outpatient charts, computerized database, and telephone survey of parents.
Results:
Six small bowel and 3 liver-small bowel transplants were carried out in 8 patients between 1993 and 1999. Median follow-up is 40 months (range, 13 to 73 months). Median age at transplantation was 2.7 years (range, 0.7 to 12.8 years). Median graft survival in this series is 15 months (range, 1 day to 71 months). Stomach and colon were excluded from all allografts. Two children died 5 and 368 days after transplant and 2 graft losses occurred in 1 patient. Two children had lymphoproliferative disease; both are alive with functioning grafts. Five survivors with functioning grafts receive full enteral feedings at home. Four of the 5 have had ileostomies closed, and 3 have normal bowel movements.
Conclusions:
Intestinal transplantation without stomach or colon provides children with chronic intestinal pseudo-obstruction with a good quality of life. The underlying disease poses special challenges in management.
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