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Preliminary experience with intestinal transplantation in infants and children
A N Langnas1, B W Shaw, D L Antonson
1Department of Surgery and Pediatrics, University of Nebraska Medical Center, Omaha, USA.
Insights
Pediatric intestinal transplantation, including combined liver and bowel procedures, shows promising survival rates and reduced reliance on total parenteral nutrition for children with short bowel syndrome. These findings suggest transplantation is a viable option for intestinal failure.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Intestinal failure significantly impacts pediatric patients, often necessitating long-term total parenteral nutrition (TPN).
- Short bowel syndrome is a primary indication for intestinal transplantation in children.
- Alternative treatment options for pediatric intestinal failure are limited.
Purpose of the Study:
- To report the initial experience with intestinal transplantation in pediatric patients.
- To evaluate the outcomes of combined liver and bowel transplantation versus isolated intestinal transplantation.
- To assess patient and graft survival rates and complications.
Main Methods:
- Retrospective analysis of 16 pediatric intestinal transplants performed over 4 years.
- Categorization into combined liver-bowel and isolated intestinal transplants.
- Evaluation of patient demographics, indications (primarily short bowel syndrome), and follow-up data.
Main Results:
- One-year survival rates for combined liver and small bowel transplants were 76% (patient) and 61% (graft).
- Six of 13 combined transplant recipients were free of TPN at follow-up.
- All three isolated intestinal transplant recipients are alive and TPN-free, with longer follow-up.
Conclusions:
- Intestinal transplantation, both combined and isolated, appears to be a viable option for pediatric intestinal failure.
- Successful transplantation can reduce or eliminate the need for long-term total parenteral nutrition.
- Further research is warranted as intestinal transplantation is still an evolving field in pediatric care.
Objective:
This report discusses the preliminary experience with intestinal transplantation in children at the University of Nebraska Medical Center.
Patients:
During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combined liver and bowel transplants, and the reminder were isolated intestinal transplants. Nearly half of the patients were younger than 1 year of age at the time of surgery, and the vast majority were younger than 5 years of age. All but one had short bowel syndrome.
Results:
The 1-year actuarial patient and graft survival rates for recipients of liver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain alive at the time of this writing, with a mean length of follow-up of 263 (range, 7 to 1223) days. Six patients are currently free of total parenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean length of follow-up is 384 (range, 330 to 450) days. Major complications have included severe infections and rejection. Lymphoproliferative disease, graft-versus-host disease, and chylous ascites have not been major problems.
Conclusions:
Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel transplants and isolated intestinal transplantation may be viable options for some patients with intestinal failure caused by short bowel syndrome or other gastrointestinal disease in whom long-term total parenteral nutrition is not an attractive option.