Long‐term Outcomes of Isolated Liver Transplantation for Short Bowel Syndrome and Intestinal Failure–associated Liver Disease

Abstract

Children with SBS and IFALD who have the potential for adaptation in the residual bowel can undergo iLTx, but it is a treatment option to be exercised with extreme caution. These children need close follow-up with an experienced multidisciplinary team to monitor nutritional outcomes and may need consideration for transplant or nontransplant surgery in the long term.

Utility of Aminotransferase/Platelet Ratio Index to Predict Liver Fibrosis in Intestinal Failure–Associated Liver Disease in Pediatric Patients

“…IFALD might have different treatment approaches including isolated intestinal transplant, isolated liver transplant in a minute number of cases, or combined liver and intestinal transplant; the prognosis and decision making in terms of which is the most appropriate indication depend, among other factors, on the degree of liver disease 18 , 19 …”

Intestinal Transplant Registry Report: Global Activity and Trends

“…Other possible factors include: inadequate reimbursement rates below the cost of performing the transplant (especially by state Medicaid agencies), the extensive infrastructure demands required to address the frequent social problems of intestinal failure patients; concern over the narrow risk-benefit ratio for IT in an era of improving outcomes with long-term total PN for selected diseases (30) and/or the limited availability of experienced personnel to fill key positions. Finally, some transplant centers may be more willing to judiciously offer isolated liver transplants to patients with the short bowel syndrome and IFALD who have the potential for further intestinal adaptation (31,32). More research is warranted to determine the specific factors contributing to the recent decline in intestine transplant case volumes.…”

Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the american association for the study of liver diseases, american society of transplantation and the north american society for pediatric gastroenterology, hepatolo

“…Patients with parenteral nutrition‐associated liver disease (PNALD) are referred for LT in the context of three clinical scenarios: 1) in combination with intestinal or multi‐visceral transplantation; 2) isolated LT (iLT) in children with intestinal failure approaching but not achieving enteral autonomy; and 3) isolated LT after enteral autonomy is achieved, but the consequences of endstage liver disease persist and impact longevity . Early reports of iLT for selected patients with PNALD were encouraging .…”