Life of patients 10 years after a successful pediatric intestinal transplantation in Europe

Abstract

A multicenter Europe-wide single-point study in intestinal transplantation (ITx) centers was conducted to identify and describe patients surviving for more than 10 years after ITx in childhood. The health and nutritional status, care requirements and psychosocial status were recorded. Among 120 transplanted before 2005, 38 patients with a functioning graft were included. Thirty (79%) had an exclusive oral diet, seven (18%) complimentary enteral nutrition for eating disorders, and one a combination of parenteral and enteral nutrition. They received a median of five drugs daily and five had a stoma. We did not observe any catch-up growth during the 10 years of follow-up. In the previous five years, 22 patients needed unplanned hospitalization with a median in-patient stay of six days. Eleven needed ongoing psychiatric follow-ups, and nine needed other specialist follow-ups. An increasing independency from parents was seen after the age of 18, with three having a stable employment and 31 pursuing education. Despite a good graft function, growth may not catch up. The burden of medical care remains high in the long term. This has to be closely followed in a multidisciplinary setting to improve long-term quality of life in these patients.

Beyond 10 years, with or without an intestinal graft: Present and future?

“…All the patients with a functional graft were weaned off PN, with the same trend noted in other long‐term studies 4,12,13 . Micronutrient deficiencies were prevalent (31%‐81%), although less than previously reported (44%‐95%) 13,14 .…”

“…We report the All the patients with a functional graft were weaned off PN, with the same trend noted in other long-term studies. 4,12,13 Micronutrient deficiencies were prevalent (31%-81%), although less than previously reported (44%-95%). 13,14 Insufficient intake and malabsorption are probable causes, with dependence on enteral nutrition identified as a risk factor.…”

“…We previously reported our experience from Necker-Enfants Malades Hospital 3 and a European study on posttransplant longterm outcomes. 4 Here, we detail specifically the digestive function and pathology beyond 10 years after ITx. We also report on outcomes after graft removal and aim to highlight the factors associated with patient and graft survival.…”

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

“…It must be emphasized that in 2017 the long-term survival and quality of life after transplantation was still unsatisfactory [ 17 , 100 ]. In 2015, the Intestinal Transplant Registry reported the results of 1611 children (822 alive at last report), 1029 with a liver-containing graft.…”

Short Bowel Syndrome as the Leading Cause of Intestinal Failure in Early Life: Some Insights into the Management

“…Among 1351 transplanted children the 5- and 10-year graft survival rate is reported as approximately 50% and 30% respectively; the 5- and 10-year patient survival rate is similar, approximately 50% and 30% respectively. In patients with a functioning graft approximately 60% have a normal function whereas 40% require partial PN or intravenous fluids [146] while QoL may improve [147]. These sobering figures mandate the adoption of all relevant strategies to avoid ITx until new protocols are available to achieve a better outcome.…”