Current perspectives on pediatric intestinal transplantation

Abstract

Irreversible intestinal failure in children is predominantly caused by surgical conditions such as volvulus, necrotizing enterocolitis, and gastroschisis. Functional intestinal failure from motility disorders such as intestinal pseudo-obstruction or enterocyte dysfunction with microvillus inclusion disease also may require intestine replacement. Approved indications for intestinal transplantation include liver dysfunction, loss of major venous access, frequent central line-related sepsis, and recurrent episodes of severe dehydration despite intravenous fluid management. Surgical options include transplantation of the isolated intestine, combined liver-intestine transplantation, or multivisceral transplantation of the stomach, duodenum, pancreas, and small bowel (with or without the liver). Immunosuppression for intestinal transplantation is based on tacrolimus therapy, often with induction immunosuppression using antilymphocyte antibodies (eg, antithymocyte antibody and alemtuzumab). Experience at centers of excellence demonstrates 1- and 5-year patient survival rates of 95% and 77%, respectively, with ongoing investigations focusing on lowering long-term causes of graft loss such as chronic rejection.

Use of an omega-3 fatty acid–based emulsion in the treatment of parenteral nutrition–induced cholestasis in patients with microvillous inclusion disease☆

“…The University of Pittsburgh, a large transplant center, performed 169 intestinal allografts from May 1990 to December 2008, including 98 liver-intestine and 71 isolated intestinal transplants with reported 1-, 3-, and 5-year patient survival (for intestinal transplants and liver/small intestinal transplants combined) of 95%, 84%, and 77%, respectively, with corresponding graft survival rates of 88%, 74%, and 58%, respectively [9]. Another center reported that the graft survival for all intestinal transplant patients at 1 year was 80% for isolated small bowel and 70% for liver/small bowel.…”

Pediatric small bowel transplantation: A single-center experience from Turkey

“…ACR is determined in the first 3 months. The historic incidence of ACR (80%) has improved to 20-50% (6,(8)(9)(10)(11). The level of ACR has declined following the use of rATG (4,12).…”

“…The incidence of CMV infection was reported at about 14% to 25% (6,11). We encountered one case of invasive CMV infection, and it was treated by IV ganciclovir.…”

Current Status of Intestinal Failure and Intestinal Transplantation

“…In one study, the 1-, 3-and 5-year patient survival of 199 children who were transplanted in Pittsburgh in the new era is 95%, 84%, and 77%, respectively. Graft survival was 88%, 74%, and 58%, respectively [55]. Poor prognostic markers included children younger than 1 year of age, no induction therapy with interleukin-2 blockers, and waiting in hospital before transplant [56].…”