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Published on: August 20, 2007
Pediatric intestinal transplantation
M López-Santamaría1, M Gámez, M Murcia
1Unit of Pediatric Liver Transplantation, Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain. mlopez.hulp@salud.madrid.org
Insights
Paediatric intestinal transplantation (IT) offers a life-saving treatment for children with intestinal failure (IF). However, high morbidity and mortality persist, alongside a critical shortage of suitable donors for very low-weight infants requiring combined liver-small bowel transplants.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Intestinal failure (IF) in children poses significant management challenges.
- Parenteral nutrition is insufficient for some IF cases, necessitating advanced interventions.
- Paediatric intestinal transplantation (IT) is a complex but vital treatment option.
Purpose of the Study:
- To analyze the outcomes of a 5-year paediatric intestinal transplantation program in Spain.
- To identify challenges and successes in paediatric IT, including donor scarcity.
- To evaluate the efficacy of isolated intestinal transplantation (IIT) versus combined liver-small bowel transplantation (LSBT).
Main Methods:
- Retrospective analysis of 18 paediatric candidates for IT over a 5-year period.
- Categorization of IF causes: short bowel syndrome, motility disorders, and congenital epithelial disorders.
- Documentation of transplant types: LSBT, isolated intestinal transplantation (IIT), and multivisceral transplantation (MVT).
Main Results:
- Eight candidates remained on the waiting list; four died before transplantation, primarily infants awaiting LSBT.
- Five children underwent successful transplantation (2 IIT, 3 LSBT).
- Post-transplant outcomes varied: two patients achieved normal diet, two died from complications (hemorrhage, lymphoproliferative disease), and one experienced graft loss due to rejection.
Conclusions:
- Paediatric intestinal transplantation (IT) is associated with high morbidity and mortality.
- IT remains the sole viable treatment for children with intestinal failure unresponsive to parenteral nutrition.
- A critical shortage of suitable donors for very low-weight infants needing LSBT presents a significant challenge.
Aim:
Analyze the results of a paediatric intestinal transplantation (IT) program in Spain.
Patients:
During an 5-year period, 18 children were included as candidates for IT. The causes for intestinal failure (IF) were short bowel syndrome (n=13), motility disorders (n=3), and congenital epithelial disorders (n=2). Nine children were admitted for a combined liver-small bowel transplant (LSBT), seven for an isolated intestinal transplantation (IIT) and two for a multivisceral transplantation (MVT). In three of the candidates for IIT the indication had to be changed to LSBT because of progression of the liver damage.
Results:
Eight candidates are on the waiting list: four for LSBT, two for IIT, and two for MVT. Four children died before transplantation. All were children under 1 year and candidates for LSBT. One child died during an attempted MVT. Five children underwent transplantation. Grafts were IIT in two and LSBT in three. Of these children, two are on a normal diet (respective follow-up times: 40 and 18 months), two died, both with functioning liver and intestinal grafts (hemorrage after liver biopsy and lymphoproliferative disease), and one developed an untreatable rejection that lead to loss of the intestinal graft; currently, she is on the waiting list for LSBT.
Conclusions:
The morbidity and mortality of IT are high, but it is the only possible treatment for children in IF who cannot be adequately managed with parenteral nutrition. A severe problem is the the scarcity of suitable donors for the very low weight children who are candidates for LSBT.
