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Updated: Jun 28, 2025
Orthotopic Small Bowel Transplantation in Rats
Published on: November 6, 2012
From intestinal failure to transplantation: Review on the current need for transplant indications under
Vikram K Raghu1, Carolina Rumbo2, Simon P Horslen1
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Advances in pediatric intestinal failure care, including parenteral nutrition and intestine transplantation, have improved survival and reduced transplant demand. However, some children still require transplantation for life-saving treatment or when parenteral nutrition becomes unmanageable.
Area of Science:
- Pediatric Gastroenterology
- Surgical Innovation
- Transplantation Medicine
Background:
- Intestinal failure (IF) significantly challenges pediatric care, necessitating careful consideration of intestine transplantation.
- Managing IF requires advanced nutritional support and surgical interventions.
- The timing of intestine transplantation is a critical decision in pediatric IF management.
Purpose of the Study:
- To outline the historical development and current state of care for pediatric intestinal failure.
- To review the roles of parenteral nutrition and intestine transplantation in managing IF.
- To discuss contemporary approaches to intestinal failure care in children.
Main Methods:
- Literature review focusing on authors' clinical experience.
- Analysis of published data on intestinal failure management.
- Synthesis of information on parenteral nutrition and intestine transplantation evolution.
Main Results:
- Parenteral nutrition (PN) and intestine transplantation have evolved significantly, with home PN becoming common.
- Complications of IF often dictate the need for intestine transplantation.
- Management strategies for pediatric IF are complex due to patient heterogeneity, impacting transplant indications.
Conclusions:
- Improved medical and surgical care have enhanced transplant-free survival in children with IF.
- The overall demand for intestine transplantation has decreased due to better management.
- Intestine transplantation remains a vital, life-saving therapy for select pediatric patients with IF or intractable PN dependence.
Introduction:
Intestinal failure, defined as the loss of gastrointestinal function to the point where nutrition cannot be maintained by enteral intake alone, presents numerous challenges in children, not least the timing of consideration of intestine transplantation.
Objectives:
To describe the evolution of care of infants and children with intestinal failure including parenteral nutrition, intestine transplantation, and contemporary intestinal failure care.
Methods:
The review is based on the authors' experience supported by an in-depth review of the published literature.
Results:
The history of parenteral nutrition, including out-patient (home) administration, and intestine transplantation are reviewed along with the complications of intestinal failure that may become indications for consideration of intestine transplantation. Current management strategies for children with intestinal failure are discussed along with changes in need for intestine transplantation, recognizing the difficulty in generalizing recommendations due to the high level of heterogeneity of intestinal pathology and residual bowel anatomy and function.
Discussion:
Advances in the medical and surgical care of children with intestinal failure have resulted in improved transplant-free survival and a significant fall in demand for transplantation. Despite these improvements a number of children continue to fail rehabilitative care and require intestine transplantation as life-saving therapy or when the burden on ongoing parenteral nutrition becomes too great to bear.
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