Related Experiment Video
Updated: Jun 16, 2026
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Pediatric small bowel transplantation
Navdeep Nayyar1, George Mazariegos, Sarangarajan Ranganathan
1Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Pediatric small bowel transplantation (SBTx) offers excellent survival rates for short gut syndrome (SGS). Further research is needed to address chronic rejection and improve long-term outcomes for transplant recipients.
Area of Science:
- Gastroenterology and Hepatology
- Transplantation Immunology
- Pediatric Surgery
Background:
- Small bowel transplantation (SBTx) has evolved significantly since its description nearly 50 years ago.
- Over 1000 children have undergone SBTx for refractory short gut syndrome (SGS) due to congenital conditions.
- SBTx gained Medicare approval in 2001 as a definitive therapy for SGS.
Purpose of the Study:
- To review the current outcomes of pediatric small bowel transplantation.
- To identify challenges in long-term graft survival.
- To highlight future research directions for improving SBTx success.
Main Methods:
- Review of historical data and current outcomes of pediatric small bowel transplantation.
- Analysis of graft survival rates and associated complications.
- Discussion of factors influencing early and late graft survival.
Main Results:
- Current 1- and 5-year graft survival rates for SBTx exceed 90% and 80%, respectively.
- Successful SBTx leads to freedom from parenteral nutrition, normalized growth, and improved quality of life.
- Recurrent rejection, immunosuppression complications, and chronic rejection impact long-term survival, particularly in SBTx without a liver graft.
Conclusions:
- Pediatric small bowel transplantation is a successful therapy for short gut syndrome with high survival rates.
- Addressing recurrent and chronic rejection is crucial for durable graft success.
- Future efforts should focus on early referral, comprehensive SGS management, understanding the liver's protective role, and elucidating inflammatory mechanisms in rejection.
Abstract:
The multivisceral liver-intestine-pancreas-stomach allograft was first described by Starzl nearly 50 years ago. Since then, over 1000 children have received small bowel transplantation (SBTx), alone or with the liver and other organs, for refractory short gut syndrome (SGS) because of a variety of congenital conditions. In 2001, SBTx was approved as definitive therapy for SGS by Medicare. Currently, 1- and 5-year graft survival routinely exceeds 90% and 80%, respectively. The expected outcomes also include freedom from parenteral nutrition, normalization of growth parameters, and quality of life. However, recurrent rejection, complications of high-dose immunosuppression, or chronic rejection, which is more likely to occur after SBTx without a liver graft, account for differences between early and late survival. Future efforts aimed at overcoming such challenges include preventing SBTx through early referral to comprehensive SGS management programs and understanding why the liver protects the small bowel allograft from rejection. Finally, inflammatory mechanisms, which predispose the highly immunogenic small bowel allograft to a protracted risk of resistant rejection must be elucidated, in order to ensure durable success.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...