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[Children with intestinal failure as candidates for intestinal transplantation]
M López Santamaría1, M Gámez, J Murcia
1S. de Gastroenterología, U. de Nutrición, S. de Hepatología, Dpto. de Cirugía, U. de Trasplantes Digestivos, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid.
Insights
Intestinal transplantation (IT) offers a life-saving option for children with permanent intestinal failure (PIF). Early referral is crucial, as delays in pediatric IT referrals significantly increase mortality rates.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Transplantation Medicine
Context:
- Intestinal transplantation (IT) is an established therapy for permanent intestinal failure (PIF).
- Pediatric patients face unique challenges, including complications from total parenteral nutrition (TPN) and limited donor availability.
- High pre-transplantation mortality is a concern in pediatric IT cases.
Purpose:
- To highlight the critical need for early referral in pediatric intestinal transplantation.
- To emphasize IT as a life-saving intervention for specific pediatric conditions.
- To analyze the outcomes of a pediatric IT program.
Summary:
- IT is a viable treatment for PIF, but pediatric cases require timely intervention.
- The study assessed 17 children for IT, with 3 currently on the waiting list for isolated or combined liver-small bowel transplantation (LSB).
- Four children died due to late referral or before transplantation, underscoring the urgency of early IT evaluation.
Impact:
- Early identification and referral for pediatric IT can improve survival rates.
- This research advocates for prompt consideration of IT in children with PIF to mitigate pre-transplantation mortality.
- The findings support the expansion of IT programs to address critical pediatric needs.
Abstract:
Small bowel is not anymore considered a forbidden organ for transplantation, and intestinal transplantation (IT) is currently used as a therapeutic option in selected cases of permanent intestinal failure (PIF). Nevertheless, the experience is still scarce, and despite recent improvements, IT is nowadays only accepted as a life-saving option. However, small children are prone to suffer complications related to TPN, particularly end stage liver disease; moreover, suitable donor for the small baby who needs an IT is seldom available. Subsequently, a high pretransplantation mortality has been reported in the pediatric series. In those cases, the indication of IT shouldn't be delayed, and these children must be referred early for IT. Since we started our IT program, 17 children have been assessed, and 3 are currently on the waiting list; two for combined liver-small bowel transplantation (LSB), both with short bowel syndrome and end stage liver disease, and one patient with microuvillous dysplasia for isolated IT (indication loss of venous access). 3 children were referred too late and died, so did a fourth patient, candidate for LSB, before he could be transplanted.