Beyond 10 years, with or without an intestinal graft: Present and future?
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Updated: Dec 24, 2025
A Rat Graft Rejection Model of Intestinal Transplantation with Exteriorized Ileostomy for Longitudinal Prognosis Assessment
Published on: June 10, 2025
Sophie Courbage1, Danielle Canioni2, Cécile Talbotec1
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France.
Insights
Long-term intestinal transplantation in children can lead to satisfactory digestive function, but requires careful monitoring for micronutrient deficiencies and psychological health. Early intervention and specific immunosuppressants improve graft survival.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Long-term outcomes of intestinal transplantation in pediatric patients are not well-established.
- Understanding the 10-year posttransplant course is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the 10-year patient and graft survival rates after intestinal transplantation in children.
- To assess long-term functional outcomes, including nutritional status, physical growth, and organ function.
- To identify factors associated with improved graft survival and long-term complications.
Main Methods:
- Retrospective analysis of 71 children undergoing intestinal transplantation between 1989 and 2007.
- Comparison of outcomes between patients with a functional graft (group 1, n=26) and without (group 2, n=9).
- Assessment of patient survival, graft survival, nutritional status, physical growth, energy absorption, histology, renal function, and complications.
Main Results:
- Ten-year patient survival was 53% and graft survival was 36%.
- Patients with functional grafts were weaned off parenteral nutrition, but experienced micronutrient deficiencies and fat malabsorption.
- Liver transplantation and a 3-drug immunosuppression regimen (sirolimus or mycophenolate mofetil) improved graft survival.
Conclusions:
- Intestinal transplantation can achieve satisfactory long-term digestive function in children.
- Graft removal without retransplantation has a better prognosis than anticipated.
- Regular micronutrient monitoring, psychological assessment, and sirolimus use are recommended.
Abstract:
Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m2 . Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.
