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Small bowel and liver/small bowel transplantation in children
1Department of Surgery, University of Pittsburgh, PA 15213.
Insights
Intestinal transplantation in children is a feasible operation, showing a 73% survival rate. Survivors are free from total parenteral nutrition, indicating improved quality of life and justifying further clinical trials.
Area of Science:
- Medicine
- Surgery
- Immunology
Background:
- Intestinal transplantation is a complex surgical procedure offering a potential solution for end-stage intestinal failure.
- Early clinical trials were essential to establish the feasibility and outcomes of this life-saving intervention.
Purpose of the Study:
- To evaluate the outcomes of a clinical trial involving intestinal transplantation in pediatric patients.
- To assess patient and graft survival rates, complications, and long-term quality of life.
Main Methods:
- A prospective clinical trial involving 11 pediatric patients undergoing either combined liver/small bowel or isolated small bowel transplantation.
- Immunosuppression was managed using FK-506 and steroids.
- Patient demographics, graft types, complications, and survival rates were meticulously recorded.
Main Results:
- An overall patient and graft survival rate of 73% was achieved.
- Three deaths occurred, attributed to graft-versus-host disease, posttransplant lymphoproliferative disease, and biliary leak.
- Survivors were successfully weaned from total parenteral nutrition, with most returning home.
Conclusions:
- Intestinal transplantation in children has evolved into a feasible and effective treatment option.
- The observed survival rates and improved quality of life support the continuation of clinical trials in this field.
Abstract:
A clinical trial of intestinal transplantation was initiated at the University of Pittsburgh in May 1990. Eleven children received either a combined liver/small bowel graft (n = 8) or an isolated small bowel graft (n = 3). Induction as well as maintenance immunosuppression was with FK-506 and steroids. Four patients were male, and seven were female; the age range was 6 months to 10.2 years. There were 3 deaths (all in recipients of the combined liver/small bowel graft), which were attributed to graft-versus-host disease (n = 1), posttransplant lymphoproliferative disease (n = 1), and biliary leak (n = 1). Transplantation of the intestine has evolved into a feasible operation, with an overall patient and graft survival rate of 73%. These survivors are free of total parenteral nutrition, and the majority are home. These encouraging results justify further clinical trials.