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[Intestinal transplantation. First experience in Spain]
M López Santamaría1, E de Vicente, M Gámez
1Dpto. de Cirugía Pediátrica, Unidad de Trasplantes Digestivos, Hospital Universitario, La Paz, Madrid.
Insights
The first intestinal transplant (IT) in Spain successfully treated a young boy with microvillous inclusion disease (MID). This life-saving procedure allowed the patient to transition from total parenteral nutrition (TPN) to oral feeding.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Pediatric Surgery
Background:
- Microvillous inclusion disease (MID) is a rare congenital disorder causing severe secretory diarrhea.
- Patients with MID often require total parenteral nutrition (TPN) and are at high risk for central venous catheter-related complications.
- Intestinal transplantation (IT) offers a potential solution for patients with intractable intestinal failure.
Observation:
- A 3-year-old boy with MID and a history of multiple sepsis episodes underwent an isolated small bowel transplant.
- The native ileocecal valve and colon were preserved during the procedure.
- Post-transplant, the patient successfully transitioned to enteral feeding and eventually regular oral intake, discontinuing TPN.
Findings:
- The patient tolerated enteral feeding within two weeks and was weaned off TPN by day 25.
- Complications included a rotavirus infection and a mild rejection episode, both managed successfully.
- The ileostomy was closed at six months post-transplant, indicating successful graft function.
Implications:
- This case demonstrates the feasibility and success of intestinal transplantation in Spain for pediatric patients with intestinal failure.
- Preservation of the recipient's native ileocecal valve and colon is possible and may be beneficial.
- Intestinal transplantation represents a viable therapeutic option for severe cases of MID, improving quality of life.
Unlabelled:
We present the first case of intestinal transplant (IT) performed in Spacin.
Case Report:
28 months old boy with secretory diarrhea since the first month of life, diagnosed of microvillous inclusion disease (MID). He is on total parenteral nutrition (TPN) and had suffered of multiple episodes of catheter related sepsis with lost of standard venous access. An isolated small bowel transplant from a cadaveric donor was performed at the age of 3 years. The native ileocaecal valve and colon were not removed.
Results:
Enteral feeding was started in the 2nd. week after the IT. On the 25th day he was off TPN. Since the 77th day, he eats regular foods by mouth. At the 6th month post IT the ileostomy was closed. Among the complications, he suffered a rotavirus infection on the 38th post IT day and an episode of mild rejection responsive to methil-prednisolone bolus.
Conclusions:
The IT is a therapeutic option that can be already offered with possibilities of success in our country. Although the colonic enterocytes express MVD, the recipient ileocaecal valve and colon can be preserved.