Anesthesia management for pediatric intestinal transplantation-a single-centre case series of eleven patients

Pediatric intestinal transplantation is the main treatment modality for children with intestinal failure who develop severe complications including intestinal failure-associated liver disease, progressive loss of central venous access, and repeated admissions requiring critical care management. We aimed to describe the perioperative management of patients undergoing intestinal transplantation at a tertiary children's hospital between 2012 and 2023, identifying challenges and potential solutions.

We retrospectively reviewed the anesthetic management of 11 children who underwent intestinal transplantation between January 2012 and August 2023. Information collected included preoperative characteristics, intraoperative management, and postoperative outcomes.

The predominant diagnosis of intestinal failure was gastroschisis (5/11, 45%), while progressive liver disease (6/11, 55%) was the main indication for transplantation. In our cohort, five patients underwent isolated intestinal transplantation, four underwent multivisceral transplantation, and two had liver and intestine transplantation. Five patients had postreperfusion syndrome, while eight (73%) patients were hypothermic (temperature [T] < 35 °C). Ten patients required at least one vasopressor/inotrope intraoperatively, with the first-line agent being norepinephrine. Three patients were extubated in the operating room; they had a median intensive care unit stay of three days. To date, the 1-year patient and graft survival rates were 91% (10/11).

With careful preoperative planning, judicious fluid management, and anticipation of potential hemodynamic instability, including postreperfusion syndrome, our data show that pediatric intestinal transplantation can be performed safely, with improved long-term outcomes compared with previous reports.