Intestinal Transplantation for Short Gut Syndrome Attributable to Necrotizing Enterocolitis

Abstract

ABSTRACT. Background. Necrotizing enterocolitis (NEC) is a life-threatening condition of the neonatal age, which frequently requires surgical intervention. After extensive bowel resection, a small proportion of these patients may develop chronic short gut syndrome (SGS) and require chronic total parenteral nutrition (TPN) use. Intestinal transplantation has been performed in these patients as a life-saving option.This study reviews our experience with intestinal transplantation for SGS attributable to NEC emphasizing the mode of presentation, natural history, timing, and outcome.Methods. A retrospective chart review was performed for all pediatric patients who underwent small bowel transplantation for NEC at the University of Miami between August 1994 and March 1999.

Gastroschisis Complicated by Midgut Atresia, Absorption of Bowel, and Closure of the Abdominal Wall Defect

“…The natural history is that of progressive liver failure and death. Transplantation of intestine/ liver has evolved into a feasible operation with an overall patient and graft survival of 55-73 months [10][11][12][13]. Even if children are candidates for transplantation, death may occur while waiting for a match.…”

“…Neonates with extensive atresia would benefit from early referral to transplant centers. Liver and intestinal transplantation replaces the diseased liver and intestine, enfranchising patients from TPN, allowing patients to go home and live a better quality of life [13].…”

Small intestinal transplantation

“…In other reports, successful transplantation has been described for intestinal failure consequent upon both necrotizing enterocolitis [16] and microvillus inclusion disease [17]. It has also been described as part of the approach to invasive desmoid tumors associated with familial adenomatous polyposis [18].…”

Ethics of emerging technologies and their transition to accepted practice: intestinal transplant for short bowel syndrome

“…[3][4][5][6][7][8][9] For the subset of patients with severe or ultra SBS who are unlikely to ever achieve bowel adaptation, small bowel transplantation is emerging as a therapeutic option. [10][11][12][13][14][15] Potential candidates for intestinal transplantation include those with ultra SBS, those with chronic intestinal failure unlikely to achieve full adaptation, and those with end-stage liver disease related to total PN. 3 Data on long-term outcomes after intestinal transplant in children have been limited.…”

“…Further, outcomes for intestinal transplant in neonates with ultra SBS, although encouraging, are even more limited to only a few small studies and case reports. 10 However, Lao et al 16 recently described more promising survival rates after intestinal transplantation in children. They found that among children who had received an intestinal transplant (median age of 1 year and median weight of 10.7 kg at the time of transplant) with available follow-up data (n ¼ 814), the overall survival rates were 73% at 1 year, 61% at 3 years and 55% at 5 years.…”