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Updated: Aug 6, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Isolated liver transplantation for decompensated end-stage liver disease in children with intestinal failure
1Columbia University Medical Center, New-York Presbyterian Hospital, 622 W. 168th Street, New York, NY 10032, USA.
Insights
Isolated liver transplantation (OLT) can be a life-saving option for infants with intestinal failure (IF) and end-stage liver disease (ESLD), potentially leading to enteral sufficiency despite higher risks.
Area of Science:
- Hepatology
- Pediatric Surgery
- Gastroenterology
Background:
- Cholestasis leading to end-stage liver disease (ESLD) is a frequent complication in infants with intestinal failure (IF).
- Isolated liver transplantation (OLT) is considered for IF patients anticipating eventual enteral feeding independence.
Purpose of the Study:
- To review the institutional experience with OLT for ESLD in patients with residual IF.
- To evaluate the outcomes and complications of OLT in this specific patient population.
Main Methods:
- Retrospective review of four IF patients who underwent OLT for ESLD between 1998 and 2004.
- Analysis of patient demographics, indications for OLT, surgical procedures, complications, and long-term outcomes, including enteral feeding status.
Main Results:
- Two of the four OLT recipients achieved enteral sufficiency post-transplantation.
- One patient remained on parenteral nutrition with partial enteral feeds, while another died from respiratory failure.
- Biliary complications occurred in two patients, with one experiencing late hepatic artery thrombosis; both were successfully managed.
Conclusions:
- OLT is a viable, emergent, life-saving procedure for IF patients with ESLD, despite associated higher morbidity due to comorbidities.
- Improved liver function and reduced portal pressures post-OLT may facilitate enteral independence.
- Careful management of parenteral nutrition after OLT can potentially prevent the need for small bowel transplantation in selected cases.
Abstract:
Cholestasis progressing to end-stage liver disease (ESLD) is common in intestinal failure (IF) in infants. Isolated liver transplantation (OLT) is performed when eventual enteral sufficiency is expected. We reviewed our experience with OLT for ESLD in patients with residual IF. From 1998 to 2004, four IF patients underwent OLT for ESLD at our institution. Three were performed as UNOS status I for acute decompensation of chronic liver failure; one other with severe cholestasis with a living donor. The living donor recipient died within months after OLT of chronic respiratory failure despite normal liver function. One recipient remains on parenteral nutrition (PN) and continues to receive partial enteral feeds with normal liver function. Two other recipients became enterally sufficient after the OLT. Biliary complications occurred in two patients, one with late hepatic artery thrombosis. Resolution was achieved with serial balloon dilatations and the other by conversion from duct-to-duct anastomosis to a choledochoduodenostomy. The morbidity of OLT for this indication is higher than for others likely because of comorbidities like sepsis and pulmonary insufficiency. OLT is complicated further by the attempt to maximally preserve residual bowel length for the biliary reconstruction. OLT can be an emergent life-saving procedure in IF patients despite higher morbidity. Improved liver function and diminished portal pressures may shorten the time to enteral sufficiency. Management of parenteral nutrition after OLT can avoid ESLD and eliminate small bowel transplantation in selected patients.
