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Updated: Aug 8, 2026
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Improved outcome of referrals for intestinal transplantation in the UK
Girish L Gupte1, Susan V Beath, Sue Protheroe
1Liver Unit, Birmingham Children's Hospital, Birmingham, UK. girish.gupte@bch.nhs.uk
Insights
Improved survival rates in children undergoing intestinal transplantation (ITx) are linked to earlier referrals and advanced surgical techniques. Key adverse factors include primary mucosal disorders, lack of nutritional support, and high bilirubin levels.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Transplantation Medicine
Background:
- Chronic intestinal failure (IF) significantly impacts pediatric patient outcomes.
- Intestinal transplantation (ITx) offers a life-saving option for select pediatric IF cases.
- Evaluating referral patterns and management strategies is crucial for optimizing ITx outcomes.
Purpose of the Study:
- To assess the outcomes of children with IF referred for ITx at Birmingham Children's Hospital (BCH).
- To identify factors associated with adverse outcomes in pediatric ITx candidates.
- To analyze the impact of post-1998 management strategies on patient survival.
Main Methods:
- Retrospective analysis of children referred for ITx assessment between January 1989 and December 2003.
- Categorization of patients into: stable on parenteral nutrition, unsuitable for ITx, or recommended for ITx.
- Comparison of outcomes between pre-1998 and post-1998 eras to evaluate strategy impact.
Main Results:
- 152 children with IF were identified; 5-year survival varied significantly by category (95% for stable, 4% for unsuitable, 35% for ITx recommended).
- Adverse survival factors included primary mucosal disorders, absence of nutritional care team involvement, and elevated serum bilirubin (>100 micromol/l).
- The post-1998 era showed improved 3-year survival (69% vs. 31%) attributed to earlier referrals (lower bilirubin levels) and advanced surgical approaches like en bloc liver/small bowel transplantation.
Conclusions:
- Earlier referral of pediatric IF patients for ITx assessment is associated with improved survival.
- Multidisciplinary care and optimized surgical strategies enhance outcomes for children undergoing ITx.
- Addressing factors like primary mucosal disorders and nutritional support is vital for successful ITx in children.
Aim:
To describe the outcome of children with intestinal failure referred to Birmingham Children's Hospital (BCH) for consideration of intestinal transplantation (ITx), to determine factors for an adverse outcome and to analyse the impact of post-1998 strategies on survival.
Subjects And Methods:
A retrospective analysis was performed of children referred for ITx assessment from January 1989 to December 2003. Children were assessed by a multidisciplinary team and categorised into: (a) stable on parenteral nutrition; (b) unsuitable for transplantation (Tx); and (c) recommended for Tx. To analyse the impact of the post-1998 strategies on survival, a comparison was made between the two eras (pre-1998 and post-1998).
Results:
152 children with chronic intestinal failure were identified (63M:89F, median age 10 months (range 1-170)). After assessment, 69 children were considered stable on parenteral nutrition (5-year survival 95%); 28 children were unsuitable for Tx (5-year survival 4%); and 55 children were recommended for Tx (5-year survival 35%, which includes 14 children who died waiting for size-matched organs). Twenty three ITx and nine isolated liver transplants (iLTx) were performed. In a multivariate analysis, the following factors in combination had an adverse effect on survival: the presence of a primary mucosal disorder (p = 0.007, OR ratio 3.16, 95% CI 1.37 to 7.31); absence of involvement of a nutritional care team at the referring hospital (p = 0.001, OR ratio 2.55, 95% CI 1.44 to 4.52); and a serum bilirubin>100 micromol/l (p = 0.001, OR ratio 3.70, 95% CI 1.84 to 7.47). Earlier referral (median serum bilirubin 78 micromol/l in the post-1998 era compared with 237 micromol/l in the pre-1998 era, p = 0.001) may be a contributory factor to improved survival. The strategies of combined en bloc reduced liver/small bowel transplantation and iLTx resulted in fewer deaths on the waiting list in the post-1998 era (2 deaths in post-1998 era v 12 deaths in pre-1998 era). The overall 3-year survival in the post-1998 era (69%) has improved compared with the pre-1998 era (31%; p<0.001) CONCLUSION: The changing characteristics at the time of referral, including earlier referral and innovative surgical strategies have resulted in improved long-term survival of children referred for ITx.
