Current perspectives on pediatric intestinal transplantation

Area of Science:

• Pediatric surgery
• Gastroenterology
• Transplantation immunology

Background:

• Pediatric intestinal failure stems from surgical conditions (e.g., necrotizing enterocolitis, gastroschisis) or functional disorders (e.g., intestinal pseudo-obstruction, microvillus inclusion disease).
• Intestine replacement becomes necessary for severe cases impacting growth and quality of life.

Purpose of the Study:

• To outline the indications, surgical approaches, immunosuppression protocols, and outcomes of intestinal transplantation in children.
• To highlight the current survival rates and future research directions in pediatric intestinal transplantation.

Main Methods:

• Review of indications for intestinal transplantation, including liver dysfunction, central line complications, and severe dehydration.
• Description of surgical techniques: isolated intestine, combined liver-intestine, and multivisceral transplantation.
• Summary of immunosuppression regimens, primarily tacrolimus-based with induction therapy.

Main Results:

• Centers of excellence report 1-year patient survival rates of 95% and 5-year survival rates of 77%.
• Key indications include liver dysfunction, loss of venous access, and recurrent sepsis or dehydration.

Conclusions:

• Intestinal transplantation is a viable option for children with irreversible intestinal failure, offering significant survival benefits.
• Ongoing research aims to mitigate long-term graft loss, particularly from chronic rejection, to further improve patient outcomes.