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Intestinal transplantation in children under FK 506 immunosuppression
1Department of Surgery, University of Pittsburgh, PA 15213.
Insights
Pediatric intestinal transplantation, alone or combined with liver transplant, is a feasible option for intestinal failure. Most patients achieve normal graft function with enteral nutrition and medication delivery.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Gastroenterology
Background:
- Intestinal failure significantly impacts pediatric quality of life.
- Current management options for intestinal failure are limited.
- Intestinal transplantation offers a potential solution for select pediatric cases.
Purpose of the Study:
- To evaluate the feasibility and outcomes of intestinal transplantation in pediatric patients.
- To assess the role of combined liver-intestinal transplantation.
- To determine the efficacy of FK 506-based immunosuppression.
Main Methods:
- Performed 10 intestinal transplantations in pediatric patients.
- Combined liver transplantation was performed in cases of liver failure and portal hypertension.
- Immunosuppression regimen primarily utilized FK 506.
Main Results:
- Two patients died from graft-versus-host disease and lymphoproliferative disease, respectively.
- One patient experienced perioperative complications requiring intensive care.
- Remaining patients demonstrated normal intestinal graft function with enteral administration of nutrition and medications.
Conclusions:
- Small bowel transplantation, either solitary or combined with liver transplantation, is a viable procedure for pediatric patients.
- Successful enteral rehabilitation is achievable post-transplantation.
- Careful patient selection and management are crucial for favorable outcomes.
Abstract:
Intestinal transplantation, solitary (n = 3) or in combination with the liver (n = 7), was performed in 10 pediatric patients with intestinal failure. The liver was only replaced if there was liver failure and portal hypertension. Immunosuppression was based on FK 506. Two patients died, one of graft-versus-host disease and one of lymphoproliferative disease. One patient as still in the intensive care unit 1 month posttransplantation due to perioperative complications. The function of the intestinal grafts in the remaining patients is normal. All nutrition and medications including immunosuppression are being administered enterally. This series indicates that small bowel transplantation, alone or in combination with the liver, is feasible in pediatric patients.